Provider Demographics
NPI:1295724359
Name:CUMMIN, DAVID L (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:L
Last Name:CUMMIN
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:PO BOX 917
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:OH
Mailing Address - Zip Code:43138-0917
Mailing Address - Country:US
Mailing Address - Phone:740-385-9646
Mailing Address - Fax:740-385-0630
Practice Address - Street 1:751 STATE ROUTE 664 N
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:OH
Practice Address - Zip Code:43138-9250
Practice Address - Country:US
Practice Address - Phone:740-385-9646
Practice Address - Fax:740-385-0630
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-20
Last Update Date:2014-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35069372207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000116518OtherANTHEM
OH0223181Medicaid
G22071Medicare UPIN
0797693Medicare ID - Type Unspecified