Provider Demographics
NPI:1770547564
Name:CUMMING, ROXANNE (MD)
Entity type:Individual
Prefix:
First Name:ROXANNE
Middle Name:
Last Name:CUMMING
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 NAMSKAKET RD
Mailing Address - Street 2:
Mailing Address - City:ORLEANS
Mailing Address - State:MA
Mailing Address - Zip Code:02653-3202
Mailing Address - Country:US
Mailing Address - Phone:508-255-4050
Mailing Address - Fax:888-448-6765
Practice Address - Street 1:3 NAMSKAKET RD
Practice Address - Street 2:
Practice Address - City:ORLEANS
Practice Address - State:MA
Practice Address - Zip Code:02653-3202
Practice Address - Country:US
Practice Address - Phone:508-255-4050
Practice Address - Fax:888-448-6765
Is Sole Proprietor?:No
Enumeration Date:2006-04-17
Last Update Date:2013-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA74512207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3117341Medicaid
074512OtherTUFTS
692607OtherHARVARD PILGRIM
692607OtherHARVARD PILGRIM
MAJ12256Medicare ID - Type Unspecified