Healthcare Provider Details

I. General information

NPI: 1821084542
Provider Name (Legal Business Name): THOMAS CUNNINGHAM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2005
Last Update Date: 12/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 MILTON AVENUE
NORTH CREEK NY
12853-0000
US

IV. Provider business mailing address

PO BOX 363
NORTH CREEK NY
12853-0363
US

V. Phone/Fax

Practice location:
  • Phone: 518-251-3216
  • Fax:
Mailing address:
  • Phone: 518-251-3216
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number093413
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: