1073618344 NPI number — DR. KARYN-ANNE B. CUMBERBATCH MD

Table of content: DR. KARYN-ANNE B. CUMBERBATCH MD (NPI 1073618344)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073618344 NPI number — DR. KARYN-ANNE B. CUMBERBATCH MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CUMBERBATCH
Provider First Name:
KARYN-ANNE
Provider Middle Name:
B.
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1073618344
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/14/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 392556
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PITTSBURGH
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15251-9556
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-806-1855
Provider Business Mailing Address Fax Number:
979-532-6790

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3640 HAMPTON DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MISSOURI CITY
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77459
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-806-1855
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , with the licence number:  J1642 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 119091004 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: J1642 . This is a "TX MEDICAL LICENSE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 8W5590 . This is a "BC/BS TX #" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: P00369794 . This is a "TRAVELER'S MEDICARE #" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 119091008 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: P01090446 . This is a "RAILROAD MEDICARE PTAN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 8DE524 . This is a "BC/BS #" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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