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General NPI Number Information
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NPI Number | 1093907081
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Entity Type | Organization
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Legal Business Name | CUMBERLAND VALLEY PSYCHIATRY PLLC
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Dates
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Enumeration Date | 08/14/2007
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Last Update Date | 09/16/2014
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Provider Practice Location Address
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Address Line | 202 W 7TH ST SUITE 113
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City | LONDON
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State | KY
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Zip | 40741-1763
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Country | US
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Telephone | 606-864-0510
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Fax | 606-864-0512
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Provider Business Mailing Address
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Address Line | 202 W 7TH ST SUITE 113
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City | LONDON
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State | KY
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Zip | 40741-1763
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Country | US
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Telephone | 606-864-0510
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Fax | 606-864-0512
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Authorized Official
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Title or Position | OWNER/MEMBER
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Name | PRATHIBA RAM
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Credential | MD
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Telephone | 606-864-0510
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 40211
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License Number State | KY
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