Provider Demographics
NPI:1518967868
Name:CUMBERLAND RADIATION ONCOLOGY, PSC
Entity Type:Organization
Organization Name:CUMBERLAND RADIATION ONCOLOGY, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AMTULLAH
Authorized Official - Middle Name:
Authorized Official - Last Name:KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:606-451-3755
Mailing Address - Street 1:112 TRADEPARK DR
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:KY
Mailing Address - Zip Code:42503-3424
Mailing Address - Country:US
Mailing Address - Phone:606-451-3755
Mailing Address - Fax:606-451-3756
Practice Address - Street 1:112 TRADEPARK DR
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42503-3424
Practice Address - Country:US
Practice Address - Phone:606-451-3755
Practice Address - Fax:606-451-3756
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY276222085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000220075OtherANTHEM PIN
KY65937245Medicaid
KYC89965OtherBLUEGRASS FAMILY HEALTH
KY2400015OtherUNITED HEALTHCARE PIN
KY2400015OtherUNITED HEALTHCARE PIN
KY=========OtherHUMANA PIN
KY=========OtherHUMANA PIN