Provider Demographics
NPI:1558619098
Name:CUNNINGHAM, PAMELA DENISE
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:DENISE
Last Name:CUNNINGHAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5625 GREENLEAF RD
Mailing Address - Street 2:
Mailing Address - City:CHEVERLY
Mailing Address - State:MD
Mailing Address - Zip Code:20785-1110
Mailing Address - Country:US
Mailing Address - Phone:202-669-8125
Mailing Address - Fax:
Practice Address - Street 1:5625 GREENLEAF RD
Practice Address - Street 2:
Practice Address - City:CHEVERLY
Practice Address - State:MD
Practice Address - Zip Code:20785-1110
Practice Address - Country:US
Practice Address - Phone:202-669-8125
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-15
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator