1194975375 NPI number — MS. EVELYN CUMBERBATCH MD

Table of content: MS. EVELYN CUMBERBATCH MD (NPI 1194975375)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194975375 NPI number — MS. EVELYN CUMBERBATCH MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CUMBERBATCH
Provider First Name:
EVELYN
Provider Middle Name:
Provider Name Prefix Text:
MS.
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:
1194975375
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/24/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
357 WHITNEY AVENUE
Provider Second Line Business Mailing Address:
#106
Provider Business Mailing Address City Name:
NEW HAVEN
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06511
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-776-1130
Provider Business Mailing Address Fax Number:
203-287-8966

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
357 WHITNEY AVENUE
Provider Second Line Business Practice Location Address:
#106
Provider Business Practice Location Address City Name:
NEW HAVEN
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06511
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-776-1130
Provider Business Practice Location Address Fax Number:
203-287-8966
Provider Enumeration Date:
09/24/2008

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: 2084P0800X , with the licence number:  039777 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2084P0800X , with the licence number: A66558 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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