Provider Demographics
NPI:1093771198
Name:DBA CUMBERLAND FAMILY PRACTICE
Entity Type:Organization
Organization Name:DBA CUMBERLAND FAMILY PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MITHU
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAUDHURI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-484-0101
Mailing Address - Street 1:2414 HOPE MILLS RD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-4264
Mailing Address - Country:US
Mailing Address - Phone:910-424-2426
Mailing Address - Fax:910-424-7916
Practice Address - Street 1:2414 HOPE MILLS RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-4264
Practice Address - Country:US
Practice Address - Phone:910-424-2426
Practice Address - Fax:910-424-7916
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89013RKMedicaid
NC0132XOtherBCBS
NC2313548Medicare ID - Type Unspecified