Basic Information
Provider Information
NPI: 1881008969
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MCCUMBERS
FirstName: RACHEL
MiddleName: ELIZABETH
NamePrefix: MRS.
NameSuffix:  
Credential: C.R.N.P.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 110 S PACA ST 7TH FLOOR
Address2:  
City: BALTIMORE
State: MD
PostalCode: 21201
CountryCode: US
TelephoneNumber: 4103285842
FaxNumber: 4103282750
Practice Location
Address1: 22 S GREENE ST
Address2:  
City: BALTIMORE
State: MD
PostalCode: 212011544
CountryCode: US
TelephoneNumber: 4103285842
FaxNumber: 4103282750
Other Information
ProviderEnumerationDate: 06/17/2014
LastUpdateDate: 07/24/2015
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000XR158249MDY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


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