Provider Demographics
NPI:1730197153
Name:CUNNINGHAM, ALICIA (MD)
Entity type:Individual
Prefix:DR
First Name:ALICIA
Middle Name:
Last Name:CUNNINGHAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 OVERLAKE PARK
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05401-4014
Mailing Address - Country:US
Mailing Address - Phone:802-862-0644
Mailing Address - Fax:
Practice Address - Street 1:181 S UNION ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-4581
Practice Address - Country:US
Practice Address - Phone:802-881-9019
Practice Address - Fax:802-318-4052
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT420011009207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1011822Medicaid
VT1011822Medicaid
VTVN3832Medicare ID - Type Unspecified