Provider Demographics
NPI:1073046561
Name:GROVES, CYNTHIA RENEE (MD)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:RENEE
Last Name:GROVES
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 1:28 EAST AVE
Mailing Address - Street 2:
Mailing Address - City:NEW CANAAN
Mailing Address - State:CT
Mailing Address - Zip Code:06840-5516
Mailing Address - Country:US
Mailing Address - Phone:203-855-3757
Mailing Address - Fax:203-594-9521
Practice Address - Street 1:28 EAST AVE
Practice Address - Street 2:
Practice Address - City:NEW CANAAN
Practice Address - State:CT
Practice Address - Zip Code:06840-5516
Practice Address - Country:US
Practice Address - Phone:203-855-3757
Practice Address - Fax:203-594-9521
Is Sole Proprietor?:No
Enumeration Date:2017-04-11
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT66598207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine