Provider Demographics
NPI:1881692820
Name:CUNNINGHAM, FRANK E JR (MD)
Entity type:Individual
Prefix:
First Name:FRANK
Middle Name:E
Last Name:CUNNINGHAM
Suffix:JR
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 1:9000 N MAIN ST
Mailing Address - Street 2:SUITE G-35
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45415-1180
Mailing Address - Country:US
Mailing Address - Phone:937-836-4361
Mailing Address - Fax:937-836-1140
Practice Address - Street 1:2261 PHILADELPHIA DR
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45406-1814
Practice Address - Country:US
Practice Address - Phone:937-734-4141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2021-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.079126207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH201763035OtherTAX ID
OH201763035026OtherCARESOURCE ID
OH2330669Medicaid
OH7812378OtherAETNA ID
OH000000353800OtherANTHEM ID
OHD7912603OtherCHOICECARE ID
OH201763035OtherTAX ID
OHD7912603OtherCHOICECARE ID
OH201763035026OtherCARESOURCE ID
OH9350411Medicare ID - Type UnspecifiedMEDICARE GROUP ID