Provider Demographics
NPI:1871683441
Name:CUNNINGHAM, DEBORAH KATHLEEN (MD)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:KATHLEEN
Last Name:CUNNINGHAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1802 BRAEBURN DR
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:VA
Mailing Address - Zip Code:24153-7357
Mailing Address - Country:US
Mailing Address - Phone:540-772-3620
Mailing Address - Fax:540-725-5016
Practice Address - Street 1:1802 BRAEBURN DR
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:VA
Practice Address - Zip Code:24153-7357
Practice Address - Country:US
Practice Address - Phone:540-772-3620
Practice Address - Fax:540-725-5016
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2011-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-3833208600000X
CAC536772086X0206X
TN37111208600000X
VA01012349762086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAVV2376AMedicare PIN
H95153Medicare UPIN
5M685Medicare ID - Type Unspecified