Healthcare Provider Details

I. General information

NPI: 1871683441
Provider Name (Legal Business Name): DEBORAH KATHLEEN CUNNINGHAM MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 08/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1802 BRAEBURN DR
SALEM VA
24153-7357
US

IV. Provider business mailing address

1802 BRAEBURN DR
SALEM VA
24153-7357
US

V. Phone/Fax

Practice location:
  • Phone: 540-772-3620
  • Fax: 540-725-5016
Mailing address:
  • Phone: 540-772-3620
  • Fax: 540-725-5016

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberE-3833
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License NumberC53677
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number37111
License Number StateTN
# 4
Primary TaxonomyN
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number0101234976
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: