Provider Demographics
NPI:1073517728
Name:CUNNINGHAM, LESLIE B (MD)
Entity Type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:B
Last Name:CUNNINGHAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1124 E WEISGARBER RD STE 104
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37909-2686
Mailing Address - Country:US
Mailing Address - Phone:865-584-0905
Mailing Address - Fax:865-584-3892
Practice Address - Street 1:1124 E WEISGARBER RD
Practice Address - Street 2:STE 100
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37909
Practice Address - Country:US
Practice Address - Phone:865-584-0905
Practice Address - Fax:865-584-3892
Is Sole Proprietor?:No
Enumeration Date:2005-06-10
Last Update Date:2018-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN21400207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0645010002OtherPTAN
TNC76620Medicare UPIN
TN3371152Medicare ID - Type Unspecified