Provider Demographics
NPI:1942400338
Name:CUMBERLAND PLASTIC SURGERY P.C.
Entity Type:Organization
Organization Name:CUMBERLAND PLASTIC SURGERY P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:ROSDEUTSCHER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:615-467-3977
Mailing Address - Street 1:5651 FRIST BLVD
Mailing Address - Street 2:STE 708
Mailing Address - City:HERMITAGE
Mailing Address - State:TN
Mailing Address - Zip Code:37076-2054
Mailing Address - Country:US
Mailing Address - Phone:615-467-3977
Mailing Address - Fax:615-889-5599
Practice Address - Street 1:5651 FRIST BLVD
Practice Address - Street 2:STE 708
Practice Address - City:HERMITAGE
Practice Address - State:TN
Practice Address - Zip Code:37076-2054
Practice Address - Country:US
Practice Address - Phone:615-467-3977
Practice Address - Fax:615-889-5599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-23
Last Update Date:2007-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN30390208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3716120Medicare PIN