Provider Demographics
NPI:1518968452
Name:KOELKER, CYNTHIA JEANETTE (MD)
Entity Type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:JEANETTE
Last Name:KOELKER
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 1:213 MASSILLON RD
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44312-1921
Mailing Address - Country:US
Mailing Address - Phone:330-733-0111
Mailing Address - Fax:
Practice Address - Street 1:213 MASSILLON RD
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44312-1921
Practice Address - Country:US
Practice Address - Phone:330-733-0111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-02
Last Update Date:2011-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.050996207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0801092Medicaid
OHA82520Medicare UPIN
OH0801092Medicaid