Provider Demographics
NPI:1598900086
Name:CUMBERLAND UROLOGY, INC.
Entity Type:Organization
Organization Name:CUMBERLAND UROLOGY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PRABHAKAR
Authorized Official - Middle Name:
Authorized Official - Last Name:PANDEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-722-7081
Mailing Address - Street 1:500 MEMORIAL AVE
Mailing Address - Street 2:SUITE 304
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21502-3732
Mailing Address - Country:US
Mailing Address - Phone:301-722-7080
Mailing Address - Fax:301-722-7081
Practice Address - Street 1:500 MEMORIAL AVE
Practice Address - Street 2:SUITE 304
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-3732
Practice Address - Country:US
Practice Address - Phone:301-722-7080
Practice Address - Fax:301-722-7081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-11
Last Update Date:2008-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0056534208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDF63911Medicare UPIN