Provider Demographics
NPI:1487150876
Name:MUTUCUMARANA, CHARMAINE PRIYANKA (MD)
Entity type:Individual
Prefix:DR
First Name:CHARMAINE
Middle Name:PRIYANKA
Last Name:MUTUCUMARANA
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:2100 WALNUT ST APT 2K
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19103-4874
Mailing Address - Country:US
Mailing Address - Phone:919-906-0968
Mailing Address - Fax:
Practice Address - Street 1:3401 CIVIC CENTER BLVD
Practice Address - Street 2:DIVISION OF PEDIATRIC INFECTIOUS DISEASES
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104
Practice Address - Country:US
Practice Address - Phone:267-425-3377
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-04
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMT224860207RI0200X, 2080P0208X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0208XAllopathic & Osteopathic PhysiciansPediatricsPediatric Infectious Diseases
No207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease