=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649647629
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BETH CUNNINGHAM, M.D., P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/26/2015
-----------------------------------------------------
Last Update Date | 08/26/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 107 RIDGELY AVE SUITE 10
-----------------------------------------------------
City | ANNAPOLIS
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21401-1417
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-598-0853
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2001 CHOPTANK AVE
-----------------------------------------------------
City | PASADENA
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21122-3523
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-598-0853
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. BETH ERIN CUNNINGHAM
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 410-598-0853
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207W00000X
-----------------------------------------------------
Taxonomy Name | Ophthalmology Physician
-----------------------------------------------------
License Number | D0062732
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------