MEDICARE: THOMAS CUNNINGHAM 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	207RX0202X	Medical Oncology Physician	093413	NY

General Provider Information

NPI Number	:	1821084542
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THOMAS CUNNINGHAM M.D.

Provider Business Mailing Address
First Line	:	PO BOX 363
Second Line	:
City	:	NORTH CREEK
State	:	NY
Zip	:	12853-0363
Country	:	US
Telephone Number	:	518-251-3216
Fax Number	:

Provider Business Practice Location Address
First Line	:	15 MILTON AVENUE
Second Line	:
City	:	NORTH CREEK
State	:	NY
Zip	:	12853-0000
Country	:	US
Telephone Number	:	518-251-3216
Fax Number	:

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

Provider Enumeration Date	:	09/27/2005
Last Update Date	:	12/20/2007

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