Healthcare Provider Details

I. General information

NPI: 1033115985
Provider Name (Legal Business Name): SEAMUS C CUNNINGHAM CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2005
Last Update Date: 03/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3639 E VIEW DR
OREFIELD PA
18069-2034
US

IV. Provider business mailing address

6109 DOMARRAY ST.
COOPERSBURG PA
18036
US

V. Phone/Fax

Practice location:
  • Phone: 610-428-1544
  • Fax: 610-395-9336
Mailing address:
  • Phone: 610-282-1941
  • Fax: 610-395-9336

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN281089-L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number044700
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: