MEDICARE: MARK CUMMINGS

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	104100000X	Social Worker	S18447	OH

General Provider Information

NPI Number	:	1336596485
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK CUMMINGS

Provider Business Mailing Address
First Line	:	195 VIRGINIA AVE
Second Line	:
City	:	WASHINGTON TOWNSHIP
State	:	OH
Zip	:	45458-2249
Country	:	US
Telephone Number	:	937-260-1034
Fax Number	:

Provider Business Practice Location Address
First Line	:	195 VIRGINIA AVE
Second Line	:
City	:	WASHINGTON TOWNSHIP
State	:	OH
Zip	:	45458-2249
Country	:	US
Telephone Number	:	937-260-1034
Fax Number	:

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

Provider Enumeration Date	:	05/18/2016
Last Update Date	:	05/18/2016

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Directions to “ MARK CUMMINGS ” Practice Location

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