Provider Demographics
NPI:1598958084
Name:CYLBURN E SODEN M.D.P.A
Entity Type:Organization
Organization Name:CYLBURN E SODEN M.D.P.A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:VIRGINIA
Authorized Official - Middle Name:DORIS
Authorized Official - Last Name:SODEN
Authorized Official - Suffix:
Authorized Official - Credentials:RN,MS
Authorized Official - Phone:301-776-1094
Mailing Address - Street 1:13920 BALTIMORE AVE
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20707-5009
Mailing Address - Country:US
Mailing Address - Phone:301-776-1094
Mailing Address - Fax:301-776-0456
Practice Address - Street 1:13920 BALTIMORE AVE
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-5009
Practice Address - Country:US
Practice Address - Phone:301-776-1094
Practice Address - Fax:301-776-0456
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-20
Last Update Date:2007-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0024150174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD448002Medicare PIN
MDB67192Medicare UPIN