Provider Demographics
NPI:1609814797
Name:LAWDER, CYNTHIA R (MD)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:R
Last Name:LAWDER
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 1:160 HIGH ROCK AVE
Mailing Address - Street 2:
Mailing Address - City:SARATOGA SPRINGS
Mailing Address - State:NY
Mailing Address - Zip Code:12866-2437
Mailing Address - Country:US
Mailing Address - Phone:518-321-4573
Mailing Address - Fax:
Practice Address - Street 1:160 HIGH ROCK AVE
Practice Address - Street 2:
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:12866-2437
Practice Address - Country:US
Practice Address - Phone:518-321-4573
Practice Address - Fax:518-841-3819
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-02
Last Update Date:2012-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY235405207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02694535Medicaid
NY02694535Medicaid
G25451Medicare UPIN