Healthcare Provider Details

I. General information

NPI: 1760458244
Provider Name (Legal Business Name): CATHERINE ANN CUNNINGHAM D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2006
Last Update Date: 03/05/2020
Certification Date: 03/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 HOSPITAL DR
CLARION PA
16214-8501
US

IV. Provider business mailing address

121 DOCTORS LN
CLARION PA
16214-8515
US

V. Phone/Fax

Practice location:
  • Phone: 814-226-3494
  • Fax: 814-226-3478
Mailing address:
  • Phone: 814-226-3470
  • Fax: 814-226-3479

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberOS010436L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberOS010436L
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier018529540005
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer
# 2
IdentifierP003162
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerGATEWAY
# 3
Identifier122156
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerUNISON

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: