Healthcare Provider Details

I. General information

NPI: 1376688978
Provider Name (Legal Business Name): MEMORIAL HOSPITAL AND MEDICAL CENTER OF CUMBERLAND INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 07/31/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 MEMORIAL AVE
CUMBERLAND MD
21502-3765
US

IV. Provider business mailing address

600 MEMORIAL AVE
CUMBERLAND MD
21502-3765
US

V. Phone/Fax

Practice location:
  • Phone: 301-723-1443
  • Fax: 301-723-1480
Mailing address:
  • Phone: 301-723-1443
  • Fax: 301-723-1480

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number State

VIII. Authorized Official

Name: KIMBERLY S REPAC
Title or Position: SR VP CFO
Credential:
Phone: 301-723-6414