1700895562 NPI number — DR. RAND J CUTHBERTSON MD

Table of content: DR. RAND J CUTHBERTSON MD (NPI 1700895562)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700895562 NPI number — DR. RAND J CUTHBERTSON MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CUTHBERTSON
Provider First Name:
RAND
Provider Middle Name:
J
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

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:
1700895562
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/21/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1428
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LIMA
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45802-1428
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
844-466-5613
Provider Business Mailing Address Fax Number:
419-223-2726

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
42 SAVAGE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHARLESTON
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29401-2410
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-474-3112
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/07/2006

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: 2085R0202X , with the licence number:  G171015 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0202X , with the licence number: 35.134166 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0202X , with the licence number: 21687 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2085R0202X , with the licence number: MD2021-0857 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 216877 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 001276200-0006 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: SC3051A948 . This is a "MEDICARE GROUP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0301423 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1700895562 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 77082524 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".




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