Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0129X | Vascular Surgeon | D0062109 | MD |
NPI | 1033206305 |
---|---|
Provider Name | Dr. Leslie Doyle Cunningham |
First Address | Boston, MA 02241-6173 |
Second Address | Hauppauge, NY 11788 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/10/2006 |
Last Update Date | 15/05/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
03276419 | (05) | NY |