Healthcare Provider Details

I. General information

NPI: 1457432247
Provider Name (Legal Business Name): CUMBERLAND CLINIC, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 04/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1210 W 5TH ST
LONDON KY
40741-2112
US

IV. Provider business mailing address

PO BOX 1300
LONDON KY
40743-1300
US

V. Phone/Fax

Practice location:
  • Phone: 606-864-4040
  • Fax: 606-877-1722
Mailing address:
  • Phone: 606-864-4040
  • Fax: 606-864-3500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: SATYABRATA CHATTERJEE
Title or Position: MANAGING MEMBER
Credential: MD
Phone: 606-864-4040