Provider Demographics
NPI:1376540849
Name:CUMMINGS SATTI, MARY (MD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:
Last Name:CUMMINGS SATTI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 VISTA DR
Mailing Address - Street 2:EASTPORT NORTH BUSINESS PARK
Mailing Address - City:OLD LYME
Mailing Address - State:CT
Mailing Address - Zip Code:06371-1537
Mailing Address - Country:US
Mailing Address - Phone:860-434-8847
Mailing Address - Fax:860-434-0428
Practice Address - Street 1:8 VISTA DR
Practice Address - Street 2:EASTPORT NORTH BUSINESS PARK
Practice Address - City:OLD LYME
Practice Address - State:CT
Practice Address - Zip Code:06371-1537
Practice Address - Country:US
Practice Address - Phone:860-434-8847
Practice Address - Fax:860-434-0428
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2015-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT033112207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001331123Medicaid
CT001331123Medicaid
CTF83917Medicare UPIN