Basic Information
| Provider Information | |||||||||
| NPI: | 1467634196 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CUNIFF | ||||||||
| FirstName: | ANDREA | ||||||||
| MiddleName: | CECCARELLI | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | CECCARELLI | ||||||||
| OtherFirstName: | ANDREA | ||||||||
| OtherMiddleName: | STEPHANIE | ||||||||
| OtherNamePrefix: | DR. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | M.D. | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1111 BENFIELD BLVD | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | MILLERSVILLE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 211083002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4107295100 | ||||||||
| FaxNumber: | 4107295156 | ||||||||
| Practice Location | |||||||||
| Address1: | 24 MAGOTHY BEACH RD STE A | ||||||||
| Address2: | |||||||||
| City: | PASADENA | ||||||||
| State: | MD | ||||||||
| PostalCode: | 211224414 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4102552700 | ||||||||
| FaxNumber: | 4104371962 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/05/2007 | ||||||||
| LastUpdateDate: | 01/24/2011 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | P20837 | MD | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207Q00000X | D0068440 | MD | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 9385370 | 01 | MD | AETNA HMO | OTHER | 957078-04 | 01 | MD | CAREFIRST- MD RENDERING | OTHER | 8246382 | 01 | MD | MAMSI | OTHER | P18916 | 01 | MD | CAREFIRST MPOS | OTHER | 6954391 | 01 | MD | AETNA PPO | OTHER | 226988 | 01 | MD | JHHC PROVIDER NUMBER | OTHER | 418708300 | 05 | MD | MEDICAID | P00794930 | 01 | MD | RAILROAD MEDICARE | OTHER | 12753739 | 01 | MD | MULTIPLAN/PHCS PROVIDER NUMBER | OTHER | 7605-0106 | 01 | MD | CAREFIRST BLUE CHOICE | OTHER |