Provider Demographics
NPI:1932124153
Name:WILLIAMS, CYNTHIA MARY (DO)
Entity Type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:MARY
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1247 PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-4412
Mailing Address - Country:US
Mailing Address - Phone:301-502-1726
Mailing Address - Fax:
Practice Address - Street 1:1247 PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-4412
Practice Address - Country:US
Practice Address - Phone:301-502-1726
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2013-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDH0058032207QH0002X
CA20A5305207QH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD015880100Medicaid
MD015880100Medicaid