Provider Demographics
NPI:1467576934
Name:SUMAWAY, CHERUBIN (MD)
Entity Type:Individual
Prefix:
First Name:CHERUBIN
Middle Name:
Last Name:SUMAWAY
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 1:8205W WARM SPRINGS RD 210
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89113-3646
Mailing Address - Country:US
Mailing Address - Phone:702-616-7660
Mailing Address - Fax:702-616-7713
Practice Address - Street 1:8205W WARM SPRINGS RD 210
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89113-3646
Practice Address - Country:US
Practice Address - Phone:702-616-7660
Practice Address - Fax:702-616-7713
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2016-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH57.012571207Q00000X
NVA13230207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1467576934Medicaid
NVCF520YMedicare PIN
NVCF520ZMedicare PIN