1013975457 NPI number — MARY E CUNNINGHAM D.O.

Table of content: MARY E CUNNINGHAM D.O. (NPI 1013975457)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013975457 NPI number — MARY E CUNNINGHAM D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CUNNINGHAM
Provider First Name:
MARY
Provider Middle Name:
E
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
F

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:
1013975457
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2 ESSEX CENTER DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PEABODY
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01960-2926
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
978-532-2800
Provider Business Mailing Address Fax Number:
978-977-4491

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2 ESSEX DR
Provider Second Line Business Practice Location Address:
INTERNAL MEDICINE
Provider Business Practice Location Address City Name:
PEABODY
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01960-2902
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
978-532-2800
Provider Business Practice Location Address Fax Number:
978-977-4492
Provider Enumeration Date:
05/03/2006

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:  73822 , 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: 0016137 . This is a "NEIGHBORHOOD HEALTH" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 073822 . This is a "TUFTS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: J11514 . This is a "BLUE CROSS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 3081265 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3214517 . This is a "AETNA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 64492 . This is a "HARVARD PILGRIM" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 7051051-002 . This is a "CIGNA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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