Provider Demographics
NPI:1396073797
Name:CUMBERLAND UROLOGY ASC, L.L.C.
Entity type:Organization
Organization Name:CUMBERLAND UROLOGY ASC, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PRABHAKAR
Authorized Official - Middle Name:
Authorized Official - Last Name:PANDEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-722-7080
Mailing Address - Street 1:217 GLENN ST
Mailing Address - Street 2:SUITE 401
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21502-2460
Mailing Address - Country:US
Mailing Address - Phone:301-722-7080
Mailing Address - Fax:301-722-7081
Practice Address - Street 1:217 GLENN ST
Practice Address - Street 2:SUITE 401
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-2460
Practice Address - Country:US
Practice Address - Phone:301-722-7080
Practice Address - Fax:301-722-7081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-23
Last Update Date:2009-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical