1326153503 NPI number — THOMAS PATRICK CUNNINGHAM III M.D.

Table of content: THOMAS PATRICK CUNNINGHAM III M.D. (NPI 1326153503)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326153503 NPI number — THOMAS PATRICK CUNNINGHAM III M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CUNNINGHAM
Provider First Name:
THOMAS
Provider Middle Name:
PATRICK
Provider Name Prefix Text:
Provider Name Suffix Text:
III
Provider Credential Text:
M.D.
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:
1326153503
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2000 WASHINGTON ST
Provider Second Line Business Mailing Address:
SUITE 546
Provider Business Mailing Address City Name:
NEWTON LOWER FALLS
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02462-1650
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-964-5020
Provider Business Mailing Address Fax Number:
617-964-3033

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2000 WASHINGTON ST
Provider Second Line Business Practice Location Address:
SUITE 546
Provider Business Practice Location Address City Name:
NEWTON LOWER FALLS
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02462-1650
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-964-5020
Provider Business Practice Location Address Fax Number:
617-964-3033
Provider Enumeration Date:
08/20/2006

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: 207R00000X , with the licence number:  39558 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 62143 . This is a "HARVARD PILGRIM HEALTHCAR" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 0402220 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 2070278 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: B33496 . This is a "BLUE SHIELD" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 039558 . This is a "TUFTS HEALTH PLAN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 62143 . This is a "PRIVATE HEALTHCARE SYSTEM" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: B10417901 . This is a "CIGNA HEALTHCARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 110045880 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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