Provider Demographics
NPI:1710965553
Name:CUMMING, KATHLEEN T
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:T
Last Name:CUMMING
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:
Other - Last Name:CROWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:75 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:NORWELL
Mailing Address - State:MA
Mailing Address - Zip Code:02061-9147
Mailing Address - Country:US
Mailing Address - Phone:781-878-5200
Mailing Address - Fax:
Practice Address - Street 1:90 LIBBEY IND PARKWAY
Practice Address - Street 2:
Practice Address - City:WEYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02189
Practice Address - Country:US
Practice Address - Phone:781-682-5900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-03
Last Update Date:2011-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA141376363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0325091Medicaid
MA04 2297845OtherTRICARE
MA04 2297845OtherGREAT WEST HEALTH CARE
MANP1552OtherBCBS
MA04 2297845OtherDOC FIRST
MA04 2297845OtherPRIVATE HEALTHCARE SYST.
MANP1552OtherBCBS
MAS71261Medicare UPIN