Provider Demographics
NPI:1710655956
Name:CHRISTOPHER MARASCALCO CUMMINS MD LLC
Entity Type:Organization
Organization Name:CHRISTOPHER MARASCALCO CUMMINS MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:CUMMINS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:662-801-2841
Mailing Address - Street 1:3016 BLACK BRIAR DR
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:MS
Mailing Address - Zip Code:38655-8934
Mailing Address - Country:US
Mailing Address - Phone:662-800-1284
Mailing Address - Fax:
Practice Address - Street 1:406 GALLERIA DR
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:MS
Practice Address - Zip Code:38655-5462
Practice Address - Country:US
Practice Address - Phone:978-444-2273
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-02
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty