Provider Demographics
NPI:1114953189
Name:CUNNINGHAM, KATHRYN J (PA-C)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:J
Last Name:CUNNINGHAM
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:531 W GERMANTOWN PIKE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PLYMOUTH MEETING
Mailing Address - State:PA
Mailing Address - Zip Code:19462-1325
Mailing Address - Country:US
Mailing Address - Phone:610-825-5741
Mailing Address - Fax:610-825-1855
Practice Address - Street 1:531 W GERMANTOWN PIKE
Practice Address - Street 2:SUITE 101
Practice Address - City:PLYMOUTH MEETING
Practice Address - State:PA
Practice Address - Zip Code:19462-1325
Practice Address - Country:US
Practice Address - Phone:610-825-5741
Practice Address - Fax:610-825-1855
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA001996L363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAQ14188Medicare UPIN
PA078353FWUMedicare ID - Type UnspecifiedHGSA