Healthcare Provider Details

I. General information

NPI: 1750301867
Provider Name (Legal Business Name): PATRICK CUMMINGS AT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1730 W 25TH ST
CLEVELAND OH
44113-3108
US

IV. Provider business mailing address

280 BROOKSIDE BLVD
HINCKLEY OH
44233-9677
US

V. Phone/Fax

Practice location:
  • Phone: 216-621-4060
  • Fax: 216-621-7322
Mailing address:
  • Phone: 330-273-4857
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License NumberAT409
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: