Provider Demographics
NPI:1215917018
Name:CUNNINGHAM, MARTIN W (MD)
Entity type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:W
Last Name:CUNNINGHAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2405 SE 17TH ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-9192
Mailing Address - Country:US
Mailing Address - Phone:352-690-2171
Mailing Address - Fax:352-690-6954
Practice Address - Street 1:1111 NE 25TH AVE
Practice Address - Street 2:SUITE 302
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34470-5667
Practice Address - Country:US
Practice Address - Phone:352-622-2221
Practice Address - Fax:352-622-4193
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2012-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME34335207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00896710OtherRR MEDICARE
FL273687000Medicaid
FL02035OtherBCBS
FL3777100001Medicare NSC
FL02035VMedicare PIN
FL02035UMedicare PIN
FL02035OtherBCBS
FLP00896710OtherRR MEDICARE