Provider Demographics
NPI:1073668703
Name:CUNNINGHAM, RICHARD LYNN SR (HIS)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:LYNN
Last Name:CUNNINGHAM
Suffix:SR
Gender:M
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 ELM TERRACE SHOPPING CENTER
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003
Mailing Address - Country:US
Mailing Address - Phone:304-242-8585
Mailing Address - Fax:304-242-8576
Practice Address - Street 1:14 ELM TERRACE SHOPPING CENTER
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003
Practice Address - Country:US
Practice Address - Phone:304-242-8585
Practice Address - Fax:304-242-8576
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV528174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist