Provider Demographics
NPI:1760580617
Name:CUNNINGHAM, PATRICK M (LIC AC)
Entity Type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:M
Last Name:CUNNINGHAM
Suffix:
Gender:M
Credentials:LIC AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 400793
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02140-0008
Mailing Address - Country:US
Mailing Address - Phone:617-489-2381
Mailing Address - Fax:
Practice Address - Street 1:360 MASSACHUSETTS AVE
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:MA
Practice Address - Zip Code:02474-6714
Practice Address - Country:US
Practice Address - Phone:617-489-2381
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2008-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA35171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist