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1467634196

NPI Code Detail

MEDICARE: DR. ANDREA CECCARELLI CUNIFF M.D.

MEDICARE: DR. ANDREA CECCARELLI CUNIFF M.D.

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	390200000X	Student in an Organized Health Care Education/Training Program	P20837	MD
2	207Q00000X	Family Medicine Physician	D0068440	MD

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
8	P00794930	OTHER	MD	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	9385370	OTHER	MD	AETNA HMO
2	957078-04	OTHER	MD	CAREFIRST- MD RENDERING
3	8246382	OTHER	MD	MAMSI
4	P18916	OTHER	MD	CAREFIRST MPOS
5	6954391	OTHER	MD	AETNA PPO
6	226988	OTHER	MD	JHHC PROVIDER NUMBER
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
9	12753739	OTHER	MD	MULTIPLAN/PHCS PROVIDER NUMBER
10	7605-0106	OTHER	MD	CAREFIRST BLUE CHOICE

General Provider Information

NPI Number	:	1467634196
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANDREA CECCARELLI CUNIFF M.D.

Provider Business Mailing Address
First Line	:	1111 BENFIELD BLVD
Second Line	:	SUITE 200
City	:	MILLERSVILLE
State	:	MD
Zip	:	21108-3002
Country	:	US
Telephone Number	:	410-729-5100
Fax Number	:	410-729-5156

Provider Business Practice Location Address
First Line	:	24 MAGOTHY BEACH RD STE A
Second Line	:
City	:	PASADENA
State	:	MD
Zip	:	21122-4414
Country	:	US
Telephone Number	:	410-255-2700
Fax Number	:	410-437-1962

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

Provider Enumeration Date	:	12/05/2007
Last Update Date	:	01/24/2011

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Directions to “ DR. ANDREA CECCARELLI CUNIFF M.D.” Practice Location

Language	Start Address	Practice Location

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