Healthcare Provider Details

I. General information

NPI: 1821101999
Provider Name (Legal Business Name): SAMUEL M CUMMINGS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 OAKRIDGE BLVD
LUMBERTON NC
28358-2330
US

IV. Provider business mailing address

800 OAKRIDGE BLVD
LUMBERTON NC
28358-2330
US

V. Phone/Fax

Practice location:
  • Phone: 910-738-2454
  • Fax: 910-671-9303
Mailing address:
  • Phone: 910-738-2454
  • Fax: 910-671-9303

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number30546
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: