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:PO BOX 1090
Mailing Address - Street 2:
Mailing Address - City:HARTSVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29551-1090
Mailing Address - Country:US
Mailing Address - Phone:843-857-0111
Mailing Address - Fax:843-309-8126
Practice Address - Street 1:812 STATE RD
Practice Address - Street 2:
Practice Address - City:CHERAW
Practice Address - State:SC
Practice Address - Zip Code:29520-2130
Practice Address - Country:US
Practice Address - Phone:843-537-0961
Practice Address - Fax:843-537-0908
Is Sole Proprietor?:No
Enumeration Date:2005-09-23
Last Update Date:2025-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC522213ES0131X, 213E00000X
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