1659314730 NPI number — DENNIS CUNNINGHAM LCPC

Table of content: DENNIS CUNNINGHAM LCPC (NPI 1659314730)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659314730 NPI number — DENNIS CUNNINGHAM LCPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CUNNINGHAM
Provider First Name:
DENNIS
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCPC
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:
1659314730
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10401 HOSPITAL DR
Provider Second Line Business Mailing Address:
SUITE G-03
Provider Business Mailing Address City Name:
CLINTON
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20735-3110
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-856-6000
Provider Business Mailing Address Fax Number:
301-856-8938

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10401 HOSPITAL DR
Provider Second Line Business Practice Location Address:
SUITE G-03
Provider Business Practice Location Address City Name:
CLINTON
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20735-3110
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-856-6000
Provider Business Practice Location Address Fax Number:
301-856-8938
Provider Enumeration Date:
06/14/2006

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: 101YP2500X , with the licence number:  LC0134 , 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: LC0134 . This is a "STATE LICENSE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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