Provider Demographics
NPI:1033115985
Name:CUNNINGHAM, SEAMUS C (CRNA)
Entity Type:Individual
Prefix:
First Name:SEAMUS
Middle Name:C
Last Name:CUNNINGHAM
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6109 DOMARRAY ST.
Mailing Address - Street 2:
Mailing Address - City:COOPERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18036
Mailing Address - Country:US
Mailing Address - Phone:610-282-1941
Mailing Address - Fax:610-395-9336
Practice Address - Street 1:3639 E VIEW DR
Practice Address - Street 2:
Practice Address - City:OREFIELD
Practice Address - State:PA
Practice Address - Zip Code:18069-2034
Practice Address - Country:US
Practice Address - Phone:610-428-1544
Practice Address - Fax:610-395-9336
Is Sole Proprietor?:No
Enumeration Date:2005-06-24
Last Update Date:2013-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN281089-L163W00000X
PA044700367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1343288OtherHIGHMARK
PA50003495OtherCAPITAL ADVANTAGE
PA11783666OtherCAQH
PA1552673OtherGATEWAY
PA0019681900001Medicaid
PA7111423OtherAETNA
PA2035948000OtherIBC
PA0019681900004Medicaid
PA76113OtherGEISINGER
PA1343288OtherFIRST PRIORITY
PA005429Medicare PIN
PA2035948000OtherIBC
PA7111423OtherAETNA
S48535Medicare UPIN