Provider Demographics
NPI:1689768731
Name:OLSON, CYNTHIA LEE (MD)
Entity Type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:LEE
Last Name:OLSON
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 1:560 TERRACE ST
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97520-3006
Mailing Address - Country:US
Mailing Address - Phone:541-840-8445
Mailing Address - Fax:
Practice Address - Street 1:560 CATALINA DR STE 200
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OR
Practice Address - Zip Code:97520-1605
Practice Address - Country:US
Practice Address - Phone:541-201-4850
Practice Address - Fax:541-201-4130
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2019-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA51133207V00000X
OR20895207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR150943Medicaid
OR150943Medicaid
OR106247Medicare ID - Type Unspecified