Provider Demographics
NPI:1619917630
Name:RICHARDS, CYNTHIA J (MD)
Entity Type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:J
Last Name:RICHARDS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:17 PEACH ORCHARD RD
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45419-2552
Mailing Address - Country:US
Mailing Address - Phone:937-307-7060
Mailing Address - Fax:999-999-9999
Practice Address - Street 1:4464 S DIXIE HWY
Practice Address - Street 2:MIDDLETOWN
Practice Address - City:MIDDLETOWN
Practice Address - State:OH
Practice Address - Zip Code:45005-5464
Practice Address - Country:US
Practice Address - Phone:543-649-8008
Practice Address - Fax:513-649-8004
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2014-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-0710712084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0074946OtherMEDICAID LEGACY NUMBER MENTAL HEALTH
OHPENDINGOtherMEDICARE PENDING FOR ACCESS COUNSELING SERVICES, LLC
OH0074861OtherMEDICAID LEGACY NUMBER CHEMICAL DEPENDENCY
OHH130910OtherMEDICARE GROUP PTAN
OH2051774Medicaid
OH311175717171OtherCARESOURCE
OHPENDINGOtherMEDICARE PENDING FOR ACCESS COUNSELING SERVICES, LLC
OHH130910OtherMEDICARE GROUP PTAN