Provider Demographics
NPI:1962556134
Name:CUMMINS, TAMBERLEY S (PA)
Entity type:Individual
Prefix:MS
First Name:TAMBERLEY
Middle Name:S
Last Name:CUMMINS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19455 DEERFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:LANSDOWNE
Mailing Address - State:VA
Mailing Address - Zip Code:20176-8100
Mailing Address - Country:US
Mailing Address - Phone:703-723-3670
Mailing Address - Fax:703-723-8336
Practice Address - Street 1:19455 DEERFIELD AVE
Practice Address - Street 2:
Practice Address - City:LANSDOWNE
Practice Address - State:VA
Practice Address - Zip Code:20176-8100
Practice Address - Country:US
Practice Address - Phone:703-723-3670
Practice Address - Fax:703-723-8336
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0003104363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDPA58535OtherCDS
MDPA58535OtherCDS