Provider Demographics
NPI:1629093885
Name:CUNNINGHAM, EUGENE EDWARD (MD)
Entity Type:Individual
Prefix:DR
First Name:EUGENE
Middle Name:EDWARD
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 1:100 MEADOW RD
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14216-3614
Mailing Address - Country:US
Mailing Address - Phone:716-898-4525
Mailing Address - Fax:716-898-3928
Practice Address - Street 1:462 GRIDER ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14215-3021
Practice Address - Country:US
Practice Address - Phone:716-898-4803
Practice Address - Fax:716-898-3928
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2012-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY116171207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00605963Medicaid
NYB71643Medicare UPIN
NYA86601Medicare ID - Type Unspecified