Basic Information
| Provider Information | |||||||||
| NPI: | 1013975457 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CUNNINGHAM | ||||||||
| FirstName: | MARY | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2 ESSEX CENTER DR | ||||||||
| Address2: | |||||||||
| City: | PEABODY | ||||||||
| State: | MA | ||||||||
| PostalCode: | 019602926 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9785322800 | ||||||||
| FaxNumber: | 9789774491 | ||||||||
| Practice Location | |||||||||
| Address1: | 2 ESSEX DR | ||||||||
| Address2: | INTERNAL MEDICINE | ||||||||
| City: | PEABODY | ||||||||
| State: | MA | ||||||||
| PostalCode: | 019602902 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9785322800 | ||||||||
| FaxNumber: | 9789774492 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/03/2006 | ||||||||
| LastUpdateDate: | 10/22/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/22/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 73822 | MA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0016137 | 01 | MA | NEIGHBORHOOD HEALTH | OTHER | 073822 | 01 | MA | TUFTS | OTHER | J11514 | 01 | MA | BLUE CROSS | OTHER | 3081265 | 05 | MA | MEDICAID | 3214517 | 01 | MA | AETNA | OTHER | 64492 | 01 | MA | HARVARD PILGRIM | OTHER | 7051051-002 | 01 | MA | CIGNA | OTHER |