Basic Information
Provider Information
NPI: 1669491593
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CUNNINGHAM
FirstName: ALLAN
MiddleName: S
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 251 SALINA MEADOWS PKWY
Address2: SUITE 100
City: SYRACUSE
State: NY
PostalCode: 132124584
CountryCode: US
TelephoneNumber: 3154642096
FaxNumber:  
Practice Location
Address1: 90 PRESIDENTIAL PLZ
Address2: 3RD FLOOR
City: SYRACUSE
State: NY
PostalCode: 132022240
CountryCode: US
TelephoneNumber: 3154644357
FaxNumber:  
Other Information
ProviderEnumerationDate: 07/19/2006
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208000000X108517NYY Allopathic & Osteopathic PhysiciansPediatrics 

No ID Information.


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