Provider Demographics
NPI:1992964043
Name:CUMBERBATCH, OPHNELL (MD)
Entity type:Individual
Prefix:
First Name:OPHNELL
Middle Name:
Last Name:CUMBERBATCH
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 1:8416 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:LANDOVER
Mailing Address - State:MD
Mailing Address - Zip Code:20785-4815
Mailing Address - Country:US
Mailing Address - Phone:301-336-3355
Mailing Address - Fax:301-336-3533
Practice Address - Street 1:8416 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:LANDOVER
Practice Address - State:MD
Practice Address - Zip Code:20785-4815
Practice Address - Country:US
Practice Address - Phone:301-336-3355
Practice Address - Fax:301-336-3533
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-04
Last Update Date:2008-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0027577207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics