MEDICARE: SCOTT MARK CUNNINGHAM DO

Medicare Provider Information

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207P00000X	Emergency Medicine Physician	34006556	OH
2	207P00000X	Emergency Medicine Physician	OS010138L	PA
3	207Q00000X	Family Medicine Physician	288392-1	NY

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
5	P00220889	OTHER	OH	MEDICARE RR-GA

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	942460636226	OTHER	OH	CARESOURCE
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

NPI Number	:	1568403624
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SCOTT MARK CUNNINGHAM DO

Provider Business Mailing Address
First Line	:	7 N ERIE ST
Second Line	:
City	:	MAYVILLE
State	:	NY
Zip	:	14757-1095
Country	:	US
Telephone Number	:	716-753-4104
Fax Number	:	716-753-4230

Provider Business Practice Location Address
First Line	:	200 E 3RD ST
Second Line	:
City	:	JAMESTOWN
State	:	NY
Zip	:	14701-5433
Country	:	US
Telephone Number	:	716-661-8330
Fax Number	:	716-661-8364

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

Provider Enumeration Date	:	06/09/2006
Last Update Date	:	07/21/2022