Provider Demographics
NPI:1093881344
Name:CUNNINGHAM, PAUL SHANNON (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:SHANNON
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 1:9131 PISCATAWAY RD
Mailing Address - Street 2:#150
Mailing Address - City:CLINTON
Mailing Address - State:MD
Mailing Address - Zip Code:20735-2510
Mailing Address - Country:US
Mailing Address - Phone:301-868-8300
Mailing Address - Fax:301-868-7250
Practice Address - Street 1:9131 PISCATAWAY RD STE 150
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MD
Practice Address - Zip Code:20735-2510
Practice Address - Country:US
Practice Address - Phone:301-868-8300
Practice Address - Fax:301-868-7250
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2012-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0044573207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD180043653OtherRAIL ROAD
G02102P01OtherMEDICARE ID TYPE UNSPECIFIED
G02102P01OtherMEDICARE ID TYPE UNSPECIFIED