Basic Information
| Provider Information | |||||||||
| NPI: | 1245376623 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CUMMINGS | ||||||||
| FirstName: | PETRINE | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | MS. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 70 HINGHAM ST | ||||||||
| Address2: | APT 1 | ||||||||
| City: | ROCKLAND | ||||||||
| State: | MA | ||||||||
| PostalCode: | 02370 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7817999564 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1115 WEST CHESTNUT ST | ||||||||
| Address2: | |||||||||
| City: | BROCKTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 02301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5085590473 | ||||||||
| FaxNumber: | 5084275361 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/30/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.