Provider Demographics
NPI:1265454219
Name:EKMAN, CYNTHIA J
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:J
Last Name:EKMAN
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 1:1718 SAINT JULIAN PL
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29204-2410
Mailing Address - Country:US
Mailing Address - Phone:803-376-8880
Mailing Address - Fax:803-376-8881
Practice Address - Street 1:1718 SAINT JULIAN PL
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29204-2410
Practice Address - Country:US
Practice Address - Phone:803-376-8880
Practice Address - Fax:803-376-8881
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC31682081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC8551Medicare PIN
SCQ34226Medicare UPIN