Healthcare Provider Details

I. General information

NPI: 1548285075
Provider Name (Legal Business Name): SUSAN STERN CUMMING M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 08/15/2024
Certification Date: 08/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 BON AIR RD 3RD FLOOR
GREENBRAE CA
94904-1702
US

IV. Provider business mailing address

100 ROWLAND WAY STE. 215
NOVATO CA
94945-5011
US

V. Phone/Fax

Practice location:
  • Phone: 415-925-7545
  • Fax: 415-925-7008
Mailing address:
  • Phone: 415-493-3311
  • Fax: 415-493-3302

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberG73589
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: