Provider Demographics
NPI:1356367098
Name:CUMMINGS, KRISTINA M (DO)
Entity type:Individual
Prefix:
First Name:KRISTINA
Middle Name:M
Last Name:CUMMINGS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:KRISTINA
Other - Middle Name:
Other - Last Name:KISSINGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:230 STEUBEN STREET
Mailing Address - Street 2:
Mailing Address - City:MONTOUR FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:14865
Mailing Address - Country:US
Mailing Address - Phone:607-535-7154
Mailing Address - Fax:607-210-1970
Practice Address - Street 1:230 STEUBEN STREET
Practice Address - Street 2:
Practice Address - City:MONTOUR FALLS
Practice Address - State:NY
Practice Address - Zip Code:14865
Practice Address - Country:US
Practice Address - Phone:607-535-7154
Practice Address - Fax:607-210-1970
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2016-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA042631207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00741947FMedicaid
GA00741947FMedicaid
GA08BBTLBMedicare ID - Type UnspecifiedMEDICARE