=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821013244
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BRIAN P CUNNINGHAM MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/13/2006
-----------------------------------------------------
Last Update Date | 05/19/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9 CHURCH ST
-----------------------------------------------------
City | ARLINGTON
-----------------------------------------------------
State | VT
-----------------------------------------------------
Zip | 05250-0061
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 802-375-6566
-----------------------------------------------------
Fax | 802-375-6828
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 61
-----------------------------------------------------
City | ARLINGTON
-----------------------------------------------------
State | VT
-----------------------------------------------------
Zip | 05250-0061
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 802-375-6566
-----------------------------------------------------
Fax | 802-375-6828
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RR0500X
-----------------------------------------------------
Taxonomy Name | Rheumatology Physician
-----------------------------------------------------
License Number | 042-0006211
-----------------------------------------------------
License Number State | VT
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | 0420006211
-----------------------------------------------------
License Number State | VT
-----------------------------------------------------