Healthcare Provider Details

I. General information

NPI: 1215917018
Provider Name (Legal Business Name): MARTIN W CUNNINGHAM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2006
Last Update Date: 01/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 NE 25TH AVE SUITE 302
OCALA FL
34470-5667
US

IV. Provider business mailing address

2405 SE 17TH ST SUITE 201
OCALA FL
34471-9192
US

V. Phone/Fax

Practice location:
  • Phone: 352-622-2221
  • Fax: 352-622-4193
Mailing address:
  • Phone: 352-690-2171
  • Fax: 352-690-6954

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberME34335
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: