1336192004 NPI number — JACQUELINE J CUNNING PA C

Table of content: JACQUELINE J CUNNING PA C (NPI 1336192004)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336192004 NPI number — JACQUELINE J CUNNING PA C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CUNNING
Provider First Name:
JACQUELINE
Provider Middle Name:
J
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA C
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:
1336192004
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/18/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
310 FARM LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DOYLESTOWN
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18901-4732
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-348-3990
Provider Business Mailing Address Fax Number:
215-348-7705

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
310 FARM LANE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DOYLESTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18904-4732
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-348-3990
Provider Business Practice Location Address Fax Number:
215-348-7705
Provider Enumeration Date:
05/17/2006

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: 364SA2200X , with the licence number:  MA050801 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0001435061 . This is a "PERSCHOICE PERSCHOICE 65" identifier . This identifiers is of the category "OTHER".
  • Identifier: 21198960001 . This is a "KEYSTONE HEALTH PLAN EAST" identifier . This identifiers is of the category "OTHER".
  • Identifier: 21198960001 . This is a "KEYSTON HLT PLAN EAST 65" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4708888939 . This is a "FIRST HEALTH CCN" identifier . This identifiers is of the category "OTHER".
  • Identifier: PC0140 . This is a "HEALTH NET" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0001435061 . This is a "PENNSULVANIA BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 598899143 . This is a "MULTI PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: P543147 . This is a "OXFORD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2119896001 . This is a "AMERIHEALTH ADMINISTRATOR" identifier . This identifiers is of the category "OTHER".
  • Identifier: 470888939 . This is a "INTERCOUNTY" identifier . This identifiers is of the category "OTHER".
  • Identifier: CK4397 . This is a "MEDICARE RAILROAD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 007302 . This is a "AETNA HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 007302 . This is a "AETNA PPO MANAGED CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: P00044991 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1058232 . This is a "KEYSTONE MERCY HEALTH PLA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2119896001 . This is a "AMERIHEALTH HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 278862 . This is a "MAMSI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4708888939 . This is a "DEVON" identifier . This identifiers is of the category "OTHER".




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