Healthcare Provider Details

I. General information

NPI: 1639334808
Provider Name (Legal Business Name): LAWRENCE E CUNNINGHAM, JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2008
Last Update Date: 07/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 LENORE TRL
CHESAPEAKE VA
23320-4823
US

IV. Provider business mailing address

109 LENORE TRL
CHESAPEAKE VA
23320-4823
US

V. Phone/Fax

Practice location:
  • Phone: 757-288-6487
  • Fax: 757-410-5143
Mailing address:
  • Phone: 757-288-6487
  • Fax: 757-410-5143

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171WH0202X
TaxonomyHome Modifications Contractor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: