Provider Demographics
NPI:1144216250
Name:CUNNINGHAM, CHARLES CASEY (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:CASEY
Last Name:CUNNINGHAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 911230
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75391-1230
Mailing Address - Country:US
Mailing Address - Phone:972-999-7800
Mailing Address - Fax:972-234-0813
Practice Address - Street 1:3535 WORTH ST
Practice Address - Street 2:SUITE 302
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246-2006
Practice Address - Country:US
Practice Address - Phone:214-370-1870
Practice Address - Fax:214-370-1860
Is Sole Proprietor?:No
Enumeration Date:2005-09-23
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG3263207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8R1421OtherBCBS
TX88249KMedicare PIN
TX8R1421OtherBCBS