Healthcare Provider Details

I. General information

NPI: 1962556134
Provider Name (Legal Business Name): TAMBERLEY S CUMMINS PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19455 DEERFIELD AVE
LANSDOWNE VA
20176-8100
US

IV. Provider business mailing address

19455 DEERFIELD AVE
LANSDOWNE VA
20176-8100
US

V. Phone/Fax

Practice location:
  • Phone: 703-723-3670
  • Fax: 703-723-8336
Mailing address:
  • Phone: 703-723-3670
  • Fax: 703-723-8336

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberC0003104
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: