Provider Demographics
NPI:1760458244
Name:CUNNINGHAM, CATHERINE ANN (DO)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:ANN
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 1:121 DOCTORS LN
Mailing Address - Street 2:
Mailing Address - City:CLARION
Mailing Address - State:PA
Mailing Address - Zip Code:16214-8515
Mailing Address - Country:US
Mailing Address - Phone:814-226-3470
Mailing Address - Fax:814-226-3479
Practice Address - Street 1:1 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:CLARION
Practice Address - State:PA
Practice Address - Zip Code:16214-8501
Practice Address - Country:US
Practice Address - Phone:814-226-3494
Practice Address - Fax:814-226-3478
Is Sole Proprietor?:No
Enumeration Date:2006-02-24
Last Update Date:2020-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS010436L207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA018529540005Medicaid
PAP003162OtherGATEWAY
PA122156OtherUNISON
PAP003162OtherGATEWAY
PA050176Medicare ID - Type Unspecified