Provider Demographics
NPI:1821013244
Name:CUNNINGHAM, BRIAN P (MD)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:P
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 61
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05250-0061
Mailing Address - Country:US
Mailing Address - Phone:802-375-6566
Mailing Address - Fax:802-375-6828
Practice Address - Street 1:9 CHURCH ST
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05250-0061
Practice Address - Country:US
Practice Address - Phone:802-375-6566
Practice Address - Fax:802-375-6828
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2016-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT042-0006211207RR0500X
VT0420006211207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT110099936OtherRAILROAD MEDICARE
OX1788OtherPTAN
VT0007997Medicaid
VT110099936OtherRAILROAD MEDICARE
VTOX1788Medicare PIN
B85802Medicare UPIN
VTB85802Medicare UPIN
VTVT7997Medicare ID - Type Unspecified