Provider Demographics
NPI:1962016279
Name:PAYNE, ANDREW CUMMING (DIPL OM, LIC AC)
Entity Type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:CUMMING
Last Name:PAYNE
Suffix:
Gender:M
Credentials:DIPL OM, LIC AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 WILLOW ST
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02909-1714
Mailing Address - Country:US
Mailing Address - Phone:413-695-8562
Mailing Address - Fax:
Practice Address - Street 1:37 WILLOW ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02909-1714
Practice Address - Country:US
Practice Address - Phone:401-297-0097
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-03
Last Update Date:2020-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA281889171100000X
RIDAOM00085171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist