Provider Demographics
NPI:1629280078
Name:CUNNINGHAM, MARA LYNN (DO)
Entity Type:Individual
Prefix:DR
First Name:MARA
Middle Name:LYNN
Last Name:CUNNINGHAM
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2999 OLYMPUS BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:COPPELL
Mailing Address - State:TX
Mailing Address - Zip Code:75019-1205
Mailing Address - Country:US
Mailing Address - Phone:469-647-4250
Mailing Address - Fax:
Practice Address - Street 1:2999 OLYMPUS BLVD STE 300
Practice Address - Street 2:
Practice Address - City:COPPELL
Practice Address - State:TX
Practice Address - Zip Code:75019-6340
Practice Address - Country:US
Practice Address - Phone:214-645-6800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-05
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM8613207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8L13121Medicare PIN