Healthcare Provider Details

I. General information

NPI: 1851580716
Provider Name (Legal Business Name): MELVIN DOUGLAS CUNNINGHAM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2007
Last Update Date: 08/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

138 LEADER AVE
LEXINGTON KY
40508-3215
US

IV. Provider business mailing address

138 LEADER AVENUE
LEXINGTON KY
40508
US

V. Phone/Fax

Practice location:
  • Phone: 859-323-1850
  • Fax:
Mailing address:
  • Phone: 859-323-1850
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number35028351
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License NumberC28637
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number17610
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: