Provider Demographics
NPI:1467634196
Name:CUNIFF, ANDREA CECCARELLI (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:CECCARELLI
Last Name:CUNIFF
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ANDREA
Other - Middle Name:STEPHANIE
Other - Last Name:CECCARELLI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1111 BENFIELD BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MILLERSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21108-3002
Mailing Address - Country:US
Mailing Address - Phone:410-729-5100
Mailing Address - Fax:410-729-5156
Practice Address - Street 1:24 MAGOTHY BEACH RD STE A
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:MD
Practice Address - Zip Code:21122-4414
Practice Address - Country:US
Practice Address - Phone:410-255-2700
Practice Address - Fax:410-437-1962
Is Sole Proprietor?:No
Enumeration Date:2007-12-05
Last Update Date:2011-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDP20837390200000X
MDD0068440207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD9385370OtherAETNA HMO
MD957078-04OtherCAREFIRST- MD RENDERING
MD8246382OtherMAMSI
MDP18916OtherCAREFIRST MPOS
MD6954391OtherAETNA PPO
MD226988OtherJHHC PROVIDER NUMBER
MD418708300Medicaid
MDP00794930OtherRAILROAD MEDICARE
MD12753739OtherMULTIPLAN/PHCS PROVIDER NUMBER
MD7605-0106OtherCAREFIRST BLUE CHOICE
MD418708300Medicaid