Provider Demographics
NPI:1245208115
Name:CUNNINGHAM, THOMAS MOFFATT III (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:MOFFATT
Last Name:CUNNINGHAM
Suffix:III
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 1:2040 RESERVE BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:TN
Mailing Address - Zip Code:37174-0735
Mailing Address - Country:US
Mailing Address - Phone:615-455-3000
Mailing Address - Fax:
Practice Address - Street 1:2040 RESERVE BLVD STE B
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:TN
Practice Address - Zip Code:37174-0735
Practice Address - Country:US
Practice Address - Phone:615-455-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2023-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2009010922085R0202X
TNMD00000461342085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY300113786OtherRAILROAD MEDICARE
WY115540700Medicaid
TNP00888634Medicare PIN
H19495Medicare UPIN
WY115540700Medicaid
NC2073943Medicare PIN
H19495Medicare UPIN