Healthcare Provider Details

I. General information

NPI: 1881697233
Provider Name (Legal Business Name): CHARLES C. CUMMINGS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2005
Last Update Date: 11/09/2021
Certification Date: 11/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1838 GREENE TREE RD STE 535
BALTIMORE MD
21208-7104
US

IV. Provider business mailing address

1838 GREENE TREE RD STE 535
BALTIMORE MD
21208-6391
US

V. Phone/Fax

Practice location:
  • Phone: 410-469-4000
  • Fax: 410-469-4074
Mailing address:
  • Phone: 410-469-4000
  • Fax: 410-469-4074

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberD0036796
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: