Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YP0228X | Pediatric Otolaryngology | 58974 | MA |
NPI | 1811988181 |
---|---|
Provider Name | Dr. Michael J. Cunningham |
First Address | Boston, MA 02114-3002 |
Second Address | Boston, MA 02114-3002 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/11/2005 |
Last Update Date | 04/08/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3019748 | (05) | MA |
B74955 | (02) | MA |