Healthcare Provider Details

I. General information

NPI: 1730380122
Provider Name (Legal Business Name): JACQUELINE ANISA CUNKELMAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2007
Last Update Date: 08/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 HOSPITAL DR FL 8
GLEN BURNIE MD
21061
US

IV. Provider business mailing address

920 ELKRIDGE LANDING RD
LINTHICUM MD
21090-2917
US

V. Phone/Fax

Practice location:
  • Phone: 410-553-8160
  • Fax: 314-362-3328
Mailing address:
  • Phone: 443-462-5010
  • Fax: 410-684-2031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberD0082900
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: