Individual
MARY THERESE CUNNANE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
4640 JEFFERSON LN NE, ALBUQUERQUE, NM 87109-2127
(505) 843-6168
(505) 792-1978
Mailing address
6320 RIVERSIDE PLAZA LN NW STE B, ALBUQUERQUE, NM 87120-1710
(505) 843-6168
(505) 792-1978
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
24905
NE
207V00000X
Obstetrics & Gynecology Physician
Primary
88-149
NM
207VG0400X
Gynecology Physician
147803-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00008169
—
NM
01
—
000927695002
BC/BS OF WESTERN NEW YORK
NY
01
—
171575CK
PREFERRED CARE
NY
01
—
5362090
AETNA
NY
01
—
P00265970
RAILROAD
NY
01
—
P010147803
BLUE CHOICE
NY
Enumeration date
04/07/2006
Last updated
07/15/2020
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