Provider Demographics
NPI:1912036740
Name:CUNNINGHAM, JAMES A (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:A
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 1:1425 VISTA LN
Mailing Address - Street 2:
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89703-4644
Mailing Address - Country:US
Mailing Address - Phone:775-883-1030
Mailing Address - Fax:775-884-6231
Practice Address - Street 1:1425 VISTA LN
Practice Address - Street 2:
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89703-4644
Practice Address - Country:US
Practice Address - Phone:775-883-1030
Practice Address - Fax:775-884-6231
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2015-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV7333208800000X
CAG70319208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVCC9681OtherANTHEM BCBS NEVADA
NV340010373OtherRR MEDICARE
NV002013042Medicaid
NVG05196Medicare UPIN
NV002013042Medicaid
NV30337Medicare ID - Type UnspecifiedFALLON MEDICARE
NVWJBJC03Medicare ID - Type UnspecifiedCARSON CITY MEDICARE
NVCC9681OtherANTHEM BCBS NEVADA
NVWJBJF03Medicare ID - Type UnspecifiedSTATELINE MEDICARE
NV340010373OtherRR MEDICARE
NV30334Medicare ID - Type UnspecifiedYERINGTON MEDICARE