Healthcare Provider Details

I. General information

NPI: 1346258985
Provider Name (Legal Business Name): MARY F. CUNNANE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 11/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 LOCUST ST SUITE 521
PHILADELPHIA PA
19107-6731
US

IV. Provider business mailing address

615 CHESTNUT ST 14TH FLOOR
PHILADELPHIA PA
19106-4404
US

V. Phone/Fax

Practice location:
  • Phone: 215-503-7822
  • Fax: 215-503-4817
Mailing address:
  • Phone: 215-955-9655
  • Fax: 215-955-2420

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZC0500X
TaxonomyCytopathology Physician
License NumberMD009345E
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberMD009345E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: