Provider Demographics
NPI:1881789345
Name:CUMMINGS, JAMES DOUGLAS (DO)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:DOUGLAS
Last Name:CUMMINGS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CHAMPLAIN SPORTS MEDICINE
Mailing Address - Street 2:67 LINCOLN STREET
Mailing Address - City:ESSEC JUNCTION
Mailing Address - State:VT
Mailing Address - Zip Code:05452
Mailing Address - Country:US
Mailing Address - Phone:802-878-1003
Mailing Address - Fax:802-878-9961
Practice Address - Street 1:CHAMPLAIN SPORTS MEDCINE
Practice Address - Street 2:67 LINCOLN STREET
Practice Address - City:ESSEX JUNCTION
Practice Address - State:VT
Practice Address - Zip Code:05452
Practice Address - Country:US
Practice Address - Phone:802-878-1003
Practice Address - Fax:802-878-9961
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT032-0000384204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT18126OtherBC/BS
VT333150OtherCIGNA
VTOVN 0160Medicaid
VT333150OtherCIGNA
VTE-00725Medicare UPIN