Healthcare Provider Details

I. General information

NPI: 1164458279
Provider Name (Legal Business Name): THELMA CUNNINGHAM CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2006
Last Update Date: 02/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3001 HOSPITAL DR
CHEVERLY MD
20785-1189
US

IV. Provider business mailing address

PO BOX 630326
BALTIMORE MD
21263-0326
US

V. Phone/Fax

Practice location:
  • Phone: 301-618-6100
  • Fax:
Mailing address:
  • Phone: 410-793-0791
  • Fax: 410-793-0809

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberR058843
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: