1033115985 NPI number — SEAMUS C CUNNINGHAM CRNA

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033115985 NPI number — SEAMUS C CUNNINGHAM CRNA

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

CUNNINGHAM

Provider First Name:

SEAMUS

Provider Middle Name:

C

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

CRNA

Provider Gender Code:

M

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:

1033115985

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

03/25/2013

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

6109 DOMARRAY ST.

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

COOPERSBURG

Provider Business Mailing Address State Name:

PA

Provider Business Mailing Address Postal Code:

18036

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

610-282-1941

Provider Business Mailing Address Fax Number:

610-395-9336

Provider First Line Business Practice Location Address:

3639 E VIEW DR

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

OREFIELD

Provider Business Practice Location Address State Name:

PA

Provider Business Practice Location Address Postal Code:

18069-2034

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

610-428-1544

Provider Business Practice Location Address Fax Number:

610-395-9336

Provider Enumeration Date:

06/24/2005

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 163W00000X , with the licence number:  RN281089-L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 367500000X , with the licence number: 044700 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 1343288 . This is a "HIGHMARK" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 50003495 . This is a "CAPITAL ADVANTAGE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 11783666 . This is a "CAQH" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 1552673 . This is a "GATEWAY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 0019681900001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
• Identifier: 7111423 . This is a "AETNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 2035948000 . This is a "IBC" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 0019681900004 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
• Identifier: 76113 . This is a "GEISINGER" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 1343288 . This is a "FIRST PRIORITY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".