Provider Demographics
NPI:1124053855
Name:MCCUNE, ANN B (MD)
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:B
Last Name:MCCUNE
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 1:2001 WATERDAM PLAZA DR
Mailing Address - Street 2:SUITE 202
Mailing Address - City:MCMURRAY
Mailing Address - State:PA
Mailing Address - Zip Code:15317-5416
Mailing Address - Country:US
Mailing Address - Phone:724-942-0610
Mailing Address - Fax:724-942-3056
Practice Address - Street 1:2001 WATERDAM PLAZA DR
Practice Address - Street 2:SUITE 202
Practice Address - City:MCMURRAY
Practice Address - State:PA
Practice Address - Zip Code:15317-5416
Practice Address - Country:US
Practice Address - Phone:724-942-0610
Practice Address - Fax:724-942-3056
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD039817E174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA608743Medicare ID - Type Unspecified
PAE55595Medicare UPIN