MEDICARE: PAUL SHANNON CUNNINGHAM MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	D0044573	MD

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	G02102P01	OTHER		MEDICARE ID TYPE UNSPECIFIED

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	180043653	OTHER	MD	RAIL ROAD

General Provider Information

NPI Number	:	1093881344
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAUL SHANNON CUNNINGHAM MD

Provider Business Mailing Address
First Line	:	9131 PISCATAWAY RD
Second Line	:	#150
City	:	CLINTON
State	:	MD
Zip	:	20735-2510
Country	:	US
Telephone Number	:	301-868-8300
Fax Number	:	301-868-7250

Provider Business Practice Location Address
First Line	:	9131 PISCATAWAY RD STE 150
Second Line	:
City	:	CLINTON
State	:	MD
Zip	:	20735-2510
Country	:	US
Telephone Number	:	301-868-8300
Fax Number	:	301-868-7250

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/28/2006
Last Update Date	:	07/31/2012

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