Provider Demographics
NPI:1992701775
Name:CUMMINS, GARY M (MD)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:M
Last Name:CUMMINS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:RI
Mailing Address - Zip Code:02840-1928
Mailing Address - Country:US
Mailing Address - Phone:401-849-4128
Mailing Address - Fax:401-736-4248
Practice Address - Street 1:211 PARK ST
Practice Address - Street 2:
Practice Address - City:ATTLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02703-0963
Practice Address - Country:US
Practice Address - Phone:401-864-2741
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-25
Last Update Date:2012-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI5290207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI9000204Medicaid
RI9000204Medicaid
RIC90007Medicare UPIN