Provider Demographics
NPI:1386695666
Name:CUMBERLAND PATHOLOGY ASSOCIATES, LLC
Entity type:Organization
Organization Name:CUMBERLAND PATHOLOGY ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES.
Authorized Official - Prefix:DR
Authorized Official - First Name:DUCKKYU
Authorized Official - Middle Name:
Authorized Official - Last Name:CHANG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:717-245-5700
Mailing Address - Street 1:45 SPRINT DR
Mailing Address - Street 2:
Mailing Address - City:CARLISLE
Mailing Address - State:PA
Mailing Address - Zip Code:17013-7696
Mailing Address - Country:US
Mailing Address - Phone:717-245-5700
Mailing Address - Fax:
Practice Address - Street 1:45 SPRINT DR
Practice Address - Street 2:
Practice Address - City:CARLISLE
Practice Address - State:PA
Practice Address - Zip Code:17013-7696
Practice Address - Country:US
Practice Address - Phone:717-245-5700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-12
Last Update Date:2007-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1013828230001Medicaid
PA091704Medicare PIN