Provider Demographics
NPI:1629135348
Name:CUNNINGHAM, GLENN DONALD (MD)
Entity Type:Individual
Prefix:
First Name:GLENN
Middle Name:DONALD
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 1:850 GOVERNOR CARLOS CAMACHO ROAD
Mailing Address - Street 2:GUAM MEMORIAL HOSPITAL AUTHORITY
Mailing Address - City:TAMUNING
Mailing Address - State:GU
Mailing Address - Zip Code:96913-3128
Mailing Address - Country:US
Mailing Address - Phone:671-647-2488
Mailing Address - Fax:671-647-2348
Practice Address - Street 1:850 GOVERNOR CARLOS CAMACHO ROAD
Practice Address - Street 2:GUAM MEMORIAL HOSPITAL AUTHORITY
Practice Address - City:TAMUNING
Practice Address - State:GU
Practice Address - Zip Code:96913-3128
Practice Address - Country:US
Practice Address - Phone:671-647-2488
Practice Address - Fax:671-647-2348
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GUM001508207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
E94596Medicare UPIN