Basic Information
| Provider Information | |||||||||
| NPI: | 1992948848 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CUMBERLAND CLINIC PLLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | CUMBERLAND CLINIC ARNP GROUP | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1300 | ||||||||
| Address2: | |||||||||
| City: | LONDON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 407431300 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6068644040 | ||||||||
| FaxNumber: | 6068643500 | ||||||||
| Practice Location | |||||||||
| Address1: | 1210 W 5TH ST | ||||||||
| Address2: | |||||||||
| City: | LONDON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 407412112 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6068644040 | ||||||||
| FaxNumber: | 6068643500 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/08/2009 | ||||||||
| LastUpdateDate: | 04/08/2009 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | CHATTERJEE | ||||||||
| AuthorizedOfficialFirstName: | SATYABRATA | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | MANAGING MEMBER | ||||||||
| AuthorizedOfficialTelephone: | 6068644040 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 4829P | KY | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.