Provider Demographics
NPI:1699761874
Name:CUNNINGHAM, DOUGLAS ELI (DPM)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:ELI
Last Name:CUNNINGHAM
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 DOCTORS DR
Mailing Address - Street 2:SUITE B-1
Mailing Address - City:CHERAW
Mailing Address - State:SC
Mailing Address - Zip Code:29520-7112
Mailing Address - Country:US
Mailing Address - Phone:843-921-6711
Mailing Address - Fax:843-921-6717
Practice Address - Street 1:110 DOCTORS DR
Practice Address - Street 2:SUITE B-1
Practice Address - City:CHERAW
Practice Address - State:SC
Practice Address - Zip Code:29520-7112
Practice Address - Country:US
Practice Address - Phone:843-921-6711
Practice Address - Fax:843-921-6717
Is Sole Proprietor?:No
Enumeration Date:2005-09-23
Last Update Date:2011-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC522213E00000X, 213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCPD5220Medicaid
SCU739100281Medicare ID - Type Unspecified
SCPD5220Medicaid
SCU73910Medicare UPIN