Provider Demographics
NPI:1952466971
Name:CULLEN UMOSELLA CULLEN & CULLEN PC
Entity Type:Organization
Organization Name:CULLEN UMOSELLA CULLEN & CULLEN PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:CULLEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-839-2790
Mailing Address - Street 1:6188 OXON HILL ROAD
Mailing Address - Street 2:SUITE 704
Mailing Address - City:OXON HILL
Mailing Address - State:MD
Mailing Address - Zip Code:20745-3151
Mailing Address - Country:US
Mailing Address - Phone:301-839-2790
Mailing Address - Fax:301-839-3042
Practice Address - Street 1:6188 OXON HILL ROAD
Practice Address - Street 2:SUITE 704
Practice Address - City:OXON HILL
Practice Address - State:MD
Practice Address - Zip Code:20745-3151
Practice Address - Country:US
Practice Address - Phone:301-839-2790
Practice Address - Fax:301-839-3042
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-27
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDCI6115OtherMEDICARE RAILROAD
KG10OtherBCBS MD
MD184800301Medicaid
KG10OtherBCBS MD
=========OtherBCBSNCA
MD184800301Medicaid