Provider Demographics
NPI:1376580050
Name:CUNDIFF, DONALD JR (MD)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:
Last Name:CUNDIFF
Suffix:JR
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 1:1912 HAYES AVE STE 1E
Mailing Address - Street 2:
Mailing Address - City:SANDUSKY
Mailing Address - State:OH
Mailing Address - Zip Code:44870-4736
Mailing Address - Country:US
Mailing Address - Phone:419-557-5541
Mailing Address - Fax:
Practice Address - Street 1:1221 HAYES AVE STE B
Practice Address - Street 2:
Practice Address - City:SANDUSKY
Practice Address - State:OH
Practice Address - Zip Code:44870-3345
Practice Address - Country:US
Practice Address - Phone:419-557-6990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2022-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-05-5630-C207R00000X
MA253754207RB0002X
OH35.055630207RB0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RB0002XAllopathic & Osteopathic PhysiciansInternal MedicineObesity Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0779840Medicaid
OH0647804Medicare PIN
E28914Medicare UPIN