Provider Demographics
NPI:1508004300
Name:CUNEO, BLAIR HOLLOWAY (PA-C)
Entity Type:Individual
Prefix:
First Name:BLAIR
Middle Name:HOLLOWAY
Last Name:CUNEO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3708 FORESTVIEW RD STE 202
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27612-2391
Mailing Address - Country:US
Mailing Address - Phone:919-999-0831
Mailing Address - Fax:888-394-6442
Practice Address - Street 1:3708 FORESTVIEW RD STE 202
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-2391
Practice Address - Country:US
Practice Address - Phone:919-999-0831
Practice Address - Fax:888-394-6442
Is Sole Proprietor?:No
Enumeration Date:2009-02-02
Last Update Date:2018-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-01697363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1508004300Medicaid
NC167FMOtherBCBS-NC
NCNC3058BMedicare PIN