Provider Demographics
NPI:1801058987
Name:STEPHANIE P. CUNNINGHAM DO PA
Entity type:Organization
Organization Name:STEPHANIE P. CUNNINGHAM DO PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:P
Authorized Official - Last Name:CUNNINGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:DO PA
Authorized Official - Phone:409-729-9222
Mailing Address - Street 1:2875 JIMMY JOHNSON BLVD # 100
Mailing Address - Street 2:
Mailing Address - City:PORT ARTHUR
Mailing Address - State:TX
Mailing Address - Zip Code:77640-2002
Mailing Address - Country:US
Mailing Address - Phone:409-729-9222
Mailing Address - Fax:409-722-9425
Practice Address - Street 1:2875 JIMMY JOHNSON BLVD # 100
Practice Address - Street 2:
Practice Address - City:PORT ARTHUR
Practice Address - State:TX
Practice Address - Zip Code:77640-2002
Practice Address - Country:US
Practice Address - Phone:409-729-9222
Practice Address - Fax:409-722-9425
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-30
Last Update Date:2016-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00194ZOtherMEDICARE
TX092341901OtherTPI
TX00194ZOtherMEDICARE