Healthcare Provider Details

I. General information

NPI: 1942298880
Provider Name (Legal Business Name): CAMERON C CUSHING MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2005
Last Update Date: 02/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4320 SEMINARY RD ALEXANDRIA HOSPITAL
ALEXANDRIA VA
22304-1535
US

IV. Provider business mailing address

1300 PICCARD DR SUITE 202
ROCKVILLE MD
20850-4303
US

V. Phone/Fax

Practice location:
  • Phone: 703-504-3066
  • Fax: 703-504-3866
Mailing address:
  • Phone: 301-921-7900
  • Fax: 301-921-7915

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number0101057734
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberD0063247
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: