Healthcare Provider Details

I. General information

NPI: 1841817764
Provider Name (Legal Business Name): KIERA CUNNINGHAM MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2020
Last Update Date: 06/24/2023
Certification Date: 06/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 SANDWICH ST
PLYMOUTH MA
02360-2183
US

IV. Provider business mailing address

275 SANDWICH ST
PLYMOUTH MA
02360-2183
US

V. Phone/Fax

Practice location:
  • Phone: 508-746-2000
  • Fax:
Mailing address:
  • Phone: 508-746-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number1014601
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: