Provider Demographics
NPI:1629087945
Name:DA CUNHA, CARL MACLIN (MD)
Entity Type:Individual
Prefix:DR
First Name:CARL
Middle Name:MACLIN
Last Name:DA CUNHA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1068 CRESTHAVEN RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-0800
Mailing Address - Country:US
Mailing Address - Phone:901-405-6454
Mailing Address - Fax:901-747-2338
Practice Address - Street 1:1068 CRESTHAVEN RD
Practice Address - Street 2:SUITE 110
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-0800
Practice Address - Country:US
Practice Address - Phone:901-405-6454
Practice Address - Fax:901-747-2338
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2015-05-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TNMD00000198962084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNVAD 000Medicare UPIN