Provider Demographics
NPI:1144395492
Name:FINE, CINDY LEE (DO)
Entity Type:Individual
Prefix:
First Name:CINDY
Middle Name:LEE
Last Name:FINE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:CINDY
Other - Middle Name:FINE
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2450 W HUNTING PARK AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19129-1302
Mailing Address - Country:US
Mailing Address - Phone:989-714-8964
Mailing Address - Fax:989-893-6819
Practice Address - Street 1:1850 9TH ST
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48708-6742
Practice Address - Country:US
Practice Address - Phone:989-714-8964
Practice Address - Fax:989-893-6819
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-22
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA254811208000000X
PAOS005193L208000000X, 2080A0000X
MICW009839208000000X
NJ25MB11689200208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine