1619987955 NPI number — DR. JANE CUNNINGHAM P.T.

Table of content: DR. JANE CUNNINGHAM P.T. (NPI 1619987955)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619987955 NPI number — DR. JANE CUNNINGHAM P.T.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CUNNINGHAM
Provider First Name:
JANE
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
P.T.
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:
1619987955
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/05/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 1732
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LA PLATA
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20646
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-392-3700
Provider Business Mailing Address Fax Number:
301-392-3876

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
101 CENTENNIAL ST
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
LA PLATA
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20646
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-392-3700
Provider Business Practice Location Address Fax Number:
301-392-3876
Provider Enumeration Date:
08/09/2006

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: 225100000X , with the licence number:  15290 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 336006 . This is a "ALLIANCE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 53485701 . This is a "BLUE CROSS OF MARYLAND" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 650023076 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: TRICARE . This is a "521983163" identifier . This identifiers is of the category "OTHER".
  • Identifier: T628 0001 . This is a "BLUE CROSS BLUE SHIELD DC" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: 147264000 . This is a "DEPT OF LABOR" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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