Healthcare Provider Details

I. General information

NPI: 1255443024
Provider Name (Legal Business Name): WILLIAM A CUMBERWORTH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

657A WEST MAPLE STREET
FARMINGTON NY
87401
US

IV. Provider business mailing address

657A WEST MAPLE STREET
FARMINGTON NY
87401
US

V. Phone/Fax

Practice location:
  • Phone: 505-325-5025
  • Fax: 505-325-0689
Mailing address:
  • Phone: 505-325-5025
  • Fax: 505-325-0689

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number70-29
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: