Provider Demographics
NPI:1407814213
Name:DEMUTH, CYNTHIA T (MD)
Entity Type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:T
Last Name:DEMUTH
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 1:409 S 2ND ST
Mailing Address - Street 2:SUITE 2F
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17104-1612
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2645 N 3RD ST
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17110-2001
Practice Address - Country:US
Practice Address - Phone:717-782-4650
Practice Address - Fax:717-782-4665
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2021-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD028293E208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001880064Medicaid
PAC28962Medicare UPIN
PA0018800640003Medicaid