Basic Information
| Provider Information | |||||||||
| NPI: | 1417132481 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CUMBERLAND EMERGENCY MEDICAL GROUP, PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1974 | ||||||||
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| City: | FREDERICK | ||||||||
| State: | MD | ||||||||
| PostalCode: | 217020974 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8666686303 | ||||||||
| FaxNumber: | 3016631703 | ||||||||
| Practice Location | |||||||||
| Address1: | 900 SETON DR | ||||||||
| Address2: | |||||||||
| City: | CUMBERLAND | ||||||||
| State: | MD | ||||||||
| PostalCode: | 215021854 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3017234000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/08/2008 | ||||||||
| LastUpdateDate: | 01/08/2008 | ||||||||
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| AuthorizedOfficialLastName: | RALEY | ||||||||
| AuthorizedOfficialFirstName: | SCOTT | ||||||||
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| AuthorizedOfficialTitleorPosition: | COO | ||||||||
| AuthorizedOfficialTelephone: | 3016631277 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine | 207P00000X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.