Provider Demographics
NPI:1508839606
Name:CUNNINGHAM, KENT N (MD)
Entity Type:Individual
Prefix:DR
First Name:KENT
Middle Name:N
Last Name:CUNNINGHAM
Suffix:
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 1:641 W WESMARK BLVD
Mailing Address - Street 2:
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29150-1900
Mailing Address - Country:US
Mailing Address - Phone:803-905-6944
Mailing Address - Fax:803-469-3944
Practice Address - Street 1:641 W WESMARK BLVD
Practice Address - Street 2:
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29150-1900
Practice Address - Country:US
Practice Address - Phone:803-905-6944
Practice Address - Fax:803-469-3944
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2013-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC14494207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCC30400OtherRRMEDICARE
SCGP5689Medicaid
SC144944Medicaid
SC9827Medicare PIN
SCC30400OtherRRMEDICARE
SCP00198223Medicare PIN