MEDICARE: DR. TRACY SUZANNE CUMMINGS MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0804X	Child & Adolescent Psychiatry Physician	35.090856	OH
2	2084P0800X	Psychiatry Physician	35.090856	OH

General Provider Information

NPI Number	:	1154432649
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TRACY SUZANNE CUMMINGS MD

Provider Business Mailing Address
First Line	:	4075 OLD WESTERN ROW RD
Second Line	:
City	:	MASON
State	:	OH
Zip	:	45040-3104
Country	:	US
Telephone Number	:	513-536-0232
Fax Number	:	513-536-0609

Provider Business Practice Location Address
First Line	:	2751 O'VARSITY WAY
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45221-3104
Country	:	US
Telephone Number	:	513-558-7700
Fax Number	:	513-558-5055

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	11/13/2023

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