Provider Demographics
NPI:1043401961
Name:CHAMPION, CYNTHIA FULLER (MT, AMT,HEW)
Entity Type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:FULLER
Last Name:CHAMPION
Suffix:
Gender:F
Credentials:MT, AMT,HEW
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 97
Mailing Address - Street 2:
Mailing Address - City:SHALLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28459-0097
Mailing Address - Country:US
Mailing Address - Phone:910-754-8043
Mailing Address - Fax:
Practice Address - Street 1:200 DELAFIELD RD
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15215-3205
Practice Address - Country:US
Practice Address - Phone:412-784-4000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-06
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246QM0706XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyMedical Technologist
No246QL0900XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyLaboratory Management