Provider Demographics
NPI:1225546526
Name:TRUITT, CYNTHIA
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:
Last Name:TRUITT
Suffix:
Gender:F
Credentials:
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 123
Mailing Address - Street 2:
Mailing Address - City:WHALEYVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21872-0123
Mailing Address - Country:US
Mailing Address - Phone:410-726-2967
Mailing Address - Fax:
Practice Address - Street 1:12641 BLUEBERRY RD
Practice Address - Street 2:
Practice Address - City:WHALEYVILLE
Practice Address - State:MD
Practice Address - Zip Code:21872-2013
Practice Address - Country:US
Practice Address - Phone:410-726-2967
Practice Address - Fax:410-726-2967
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-21
Last Update Date:2018-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251X00000XAgenciesSupports Brokerage