Provider Demographics
NPI:1821003344
Name:KUMMER, REX E (MD)
Entity Type:Individual
Prefix:DR
First Name:REX
Middle Name:E
Last Name:KUMMER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 BLUE BEECH WAY
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-3811
Mailing Address - Country:US
Mailing Address - Phone:757-547-0210
Mailing Address - Fax:
Practice Address - Street 1:420 BLUE BEECH WAY
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-3811
Practice Address - Country:US
Practice Address - Phone:757-547-0210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2013-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-062162208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036062162 1Medicaid
279500OtherMEDICARE GROUP
370001206OtherRAILROAD MEDICARE
ILC38746Medicare UPIN
IL036062162 1Medicaid
IL0407950001Medicare NSC