Provider Demographics
NPI:1497133250
Name:CUMBERLAND, MARK ALLEN
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:ALLEN
Last Name:CUMBERLAND
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24385 DEER CREEK DR
Mailing Address - Street 2:
Mailing Address - City:FLAT ROCK
Mailing Address - State:MI
Mailing Address - Zip Code:48134-1786
Mailing Address - Country:US
Mailing Address - Phone:734-925-3584
Mailing Address - Fax:
Practice Address - Street 1:24385 DEER CREEK DR
Practice Address - Street 2:
Practice Address - City:FLAT ROCK
Practice Address - State:MI
Practice Address - Zip Code:48134-1786
Practice Address - Country:US
Practice Address - Phone:734-925-3584
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-13
Last Update Date:2015-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide