Provider Demographics
NPI:1518955962
Name:MCCUNNIFF, DENNIS EDWARD (MD)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:EDWARD
Last Name:MCCUNNIFF
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 1:1806 S HAWTHORNE RD
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-4014
Mailing Address - Country:US
Mailing Address - Phone:336-768-3632
Mailing Address - Fax:336-736-4473
Practice Address - Street 1:1806 S HAWTHORNE RD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-4014
Practice Address - Country:US
Practice Address - Phone:336-768-3632
Practice Address - Fax:336-736-4473
Is Sole Proprietor?:No
Enumeration Date:2005-10-10
Last Update Date:2014-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC26961207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8955961Medicaid
NC8955961Medicaid
NC213066DMedicare ID - Type Unspecified