Provider Demographics
NPI:1003077363
Name:WILSON, CYNTHIA IRBY (MD)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:IRBY
Last Name:WILSON
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 1:8 FARMFIELD AVE STE D
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407-7779
Mailing Address - Country:US
Mailing Address - Phone:843-469-5641
Mailing Address - Fax:
Practice Address - Street 1:8 FARMFIELD AVE STE D
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-7779
Practice Address - Country:US
Practice Address - Phone:843-469-5641
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-19
Last Update Date:2012-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCMMD.31950207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology