Provider Demographics
NPI:1851337794
Name:SU, CYNTHIA C (MD)
Entity Type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:C
Last Name:SU
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 1:1788 REPUBLIC RD
Mailing Address - Street 2:STE 200
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23454-4552
Mailing Address - Country:US
Mailing Address - Phone:757-422-2966
Mailing Address - Fax:757-422-4563
Practice Address - Street 1:1788 REPUBLIC RD
Practice Address - Street 2:STE 200
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23454-4552
Practice Address - Country:US
Practice Address - Phone:757-422-2966
Practice Address - Fax:757-422-4563
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01018404162081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890501LMedicaid
2001309OtherUNITED HEALTH CARE
23115888OtherTRICARE
VA259888OtherBLUE CROSS BLUE SHIELD
VA62840OtherSENTARA/ OPTIMA
VA000001A02Medicare ID - Type UnspecifiedTRAILBLAZERS
NC890501LMedicaid