Provider Demographics
NPI:1306863030
Name:KNUTSON, CYNTHIA ACKERMAN (MD)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:ACKERMAN
Last Name:KNUTSON
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 1:660 SW 39TH ST STE 150
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98057-4912
Mailing Address - Country:US
Mailing Address - Phone:425-690-3483
Mailing Address - Fax:425-690-9083
Practice Address - Street 1:660 SW 39TH ST STE 150
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98057-4912
Practice Address - Country:US
Practice Address - Phone:425-690-3483
Practice Address - Fax:425-690-9083
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ20368207N00000X, 207ND0101X, 207NS0135X
WAMD60661694207ND0101X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2074044Medicaid
AZ395021Medicaid
AZ070010620OtherRR MEDICARE
WAG8983904OtherMEDICARE