Provider Demographics
NPI:1396737532
Name:CUMBO, THOMAS JOHN (MD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:JOHN
Last Name:CUMBO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:354 LINCOLN PKWY
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14216-3121
Mailing Address - Country:US
Mailing Address - Phone:716-873-8311
Mailing Address - Fax:716-447-9152
Practice Address - Street 1:354 LINCOLN PKWY
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14216-3121
Practice Address - Country:US
Practice Address - Phone:716-873-8311
Practice Address - Fax:716-447-9152
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-15
Last Update Date:2012-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY103661207R00000X, 207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00677770Medicaid
NY00677770Medicaid
B71513Medicare UPIN