MEDICARE: JOANNE C. CUNANAN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	MD11943	RI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1933	OTHER	RI	NEIHBORHOOD HEALTH PLAN

General Provider Information

NPI Number	:	1639152663
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOANNE C. CUNANAN MD

Provider Business Mailing Address
First Line	:	18 LOG CABIN RD
Second Line	:
City	:	SICKLERVILLE
State	:	NJ
Zip	:	08081-5655
Country	:	US
Telephone Number	:	401-741-5644
Fax Number	:

Provider Business Practice Location Address
First Line	:	18 LOG CABIN RD
Second Line	:
City	:	SICKLERVILLE
State	:	NJ
Zip	:	08081-5655
Country	:	US
Telephone Number	:	401-741-5644
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/23/2005
Last Update Date	:	11/26/2007

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