Provider Demographics
NPI:1821084542
Name:CUNNINGHAM, THOMAS (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:
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:PO BOX 363
Mailing Address - Street 2:
Mailing Address - City:NORTH CREEK
Mailing Address - State:NY
Mailing Address - Zip Code:12853-0363
Mailing Address - Country:US
Mailing Address - Phone:518-251-3216
Mailing Address - Fax:
Practice Address - Street 1:15 MILTON AVENUE
Practice Address - Street 2:
Practice Address - City:NORTH CREEK
Practice Address - State:NY
Practice Address - Zip Code:12853-0000
Practice Address - Country:US
Practice Address - Phone:518-251-3216
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-27
Last Update Date:2007-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY093413207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CC5012Medicare PIN
D78425Medicare UPIN
54N932Medicare PIN
CC5023Medicare PIN