Provider Demographics
NPI:1508067778
Name:MARCO, CYNTHIA DAWN (BACHELOR OF SCIENCE)
Entity Type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:DAWN
Last Name:MARCO
Suffix:
Gender:F
Credentials:BACHELOR OF SCIENCE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 HICE ST
Mailing Address - Street 2:
Mailing Address - City:BELINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:26250
Mailing Address - Country:US
Mailing Address - Phone:304-823-2047
Mailing Address - Fax:
Practice Address - Street 1:971 HARRISON AVE
Practice Address - Street 2:
Practice Address - City:ELKINS
Practice Address - State:WV
Practice Address - Zip Code:26241
Practice Address - Country:US
Practice Address - Phone:304-636-9450
Practice Address - Fax:304-636-7057
Is Sole Proprietor?:No
Enumeration Date:2007-05-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0023397001Medicaid