Provider Demographics
NPI:1104083872
Name:CUNNINGHAM, CAROLYN ANN (MD)
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:ANN
Last Name:CUNNINGHAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4000 N MERIDIAN ST APT 6H
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46208-4024
Mailing Address - Country:US
Mailing Address - Phone:317-590-8692
Mailing Address - Fax:317-923-7183
Practice Address - Street 1:4000 N MERIDIAN ST APT 6H
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46208-4024
Practice Address - Country:US
Practice Address - Phone:317-590-8692
Practice Address - Fax:317-923-7183
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-20
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01021460B207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
INC24242Medicare UPIN