Provider Demographics
NPI:1457493942
Name:CUNNINGHAM, TIMOTHY CHARLES
Entity Type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:CHARLES
Last Name:CUNNINGHAM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 COURT ST
Mailing Address - Street 2:APT. D
Mailing Address - City:KEENE
Mailing Address - State:NH
Mailing Address - Zip Code:03431-3406
Mailing Address - Country:US
Mailing Address - Phone:603-852-2762
Mailing Address - Fax:
Practice Address - Street 1:17 93RD ST
Practice Address - Street 2:
Practice Address - City:KEENE
Practice Address - State:NH
Practice Address - Zip Code:03431-3748
Practice Address - Country:US
Practice Address - Phone:603-357-5270
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator