Provider Demographics
NPI:1518934884
Name:CUSHMAN, CYNTHIA CLARK (MD)
Entity Type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:CLARK
Last Name:CUSHMAN
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 1:110 MARGINAL WAY # 270
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04101-2442
Mailing Address - Country:US
Mailing Address - Phone:413-822-3037
Mailing Address - Fax:
Practice Address - Street 1:110 MARGINAL WAY # 270
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101-2442
Practice Address - Country:US
Practice Address - Phone:413-822-3037
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-04
Last Update Date:2015-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1596162084P0800X
MEMD190322084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
F97212Medicare UPIN
955190YMedicare ID - Type Unspecified