Healthcare Provider Details

I. General information

NPI: 1992701775
Provider Name (Legal Business Name): GARY M CUMMINS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2005
Last Update Date: 02/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 PARK ST
ATTLEBORO MA
02703-0963
US

IV. Provider business mailing address

40 WALNUT ST
NEWPORT RI
02840-1928
US

V. Phone/Fax

Practice location:
  • Phone: 401-864-2741
  • Fax:
Mailing address:
  • Phone: 401-849-4128
  • Fax: 401-736-4248

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5290
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: