Provider Demographics
NPI:1457432247
Name:CUMBERLAND CLINIC, PLLC
Entity Type:Organization
Organization Name:CUMBERLAND CLINIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:SATYABRATA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHATTERJEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:606-864-4040
Mailing Address - Street 1:PO BOX 1300
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40743-1300
Mailing Address - Country:US
Mailing Address - Phone:606-864-4040
Mailing Address - Fax:606-864-3500
Practice Address - Street 1:1210 W 5TH ST
Practice Address - Street 2:
Practice Address - City:LONDON
Practice Address - State:KY
Practice Address - Zip Code:40741-2112
Practice Address - Country:US
Practice Address - Phone:606-864-4040
Practice Address - Fax:606-877-1722
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac ElectrophysiologyGroup - Multi-Specialty
No207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000503391OtherBCBS OF KY
KY7100020740Medicaid
612029800OtherFEDERAL BLACK LUNG GROUP NUMBER
KYDG2095Medicare PIN
612029800OtherFEDERAL BLACK LUNG GROUP NUMBER