Basic Information
| Provider Information | |||||||||
| NPI: | 1043256829 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CUMAGUN | ||||||||
| FirstName: | MARIA ROSARIO | ||||||||
| MiddleName: | ABANO | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 810 SAINT VINCENTS DR | ||||||||
| Address2: | |||||||||
| City: | BIRMINGHAM | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352051601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2055583484 | ||||||||
| FaxNumber: | 2059302158 | ||||||||
| Practice Location | |||||||||
| Address1: | 1870 CHACE DR STE 160 | ||||||||
| Address2: | |||||||||
| City: | HOOVER | ||||||||
| State: | AL | ||||||||
| PostalCode: | 35244 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2057337110 | ||||||||
| FaxNumber: | 2057337859 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/21/2006 | ||||||||
| LastUpdateDate: | 08/05/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RI0200X | 19723 | AL | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease | 207R00000X | 19723 | AL | N | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 510I110191 | 01 | AL | MEDICARE PTAN | OTHER | 000096053 | 05 | AL | MEDICAID | 009914208 | 05 | AL | MEDICAID | 51545897 | 01 | AL | BCBS | OTHER |