Provider Demographics
NPI:1629177092
Name:SORTWELL, CYNTHIA (MD)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:
Last Name:SORTWELL
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 1:30 DANFORTH ST
Mailing Address - Street 2:SUITE 312
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04101-4502
Mailing Address - Country:US
Mailing Address - Phone:207-879-2556
Mailing Address - Fax:
Practice Address - Street 1:30 DANFORTH ST
Practice Address - Street 2:SUITE 312
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101-4502
Practice Address - Country:US
Practice Address - Phone:207-879-2556
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2015-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME0111332084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME213890000Medicaid
MEMM3817Medicare ID - Type Unspecified
ME271350OtherMAGELLAN
ME003319OtherANTHEM