Provider Demographics
NPI:1023017506
Name:CRITTENDON, CINDY (DO)
Entity type:Individual
Prefix:DR
First Name:CINDY
Middle Name:
Last Name:CRITTENDON
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 1:1076 MARLBORO WAY
Mailing Address - Street 2:SUITE 1
Mailing Address - City:BENNETTSVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29512-2495
Mailing Address - Country:US
Mailing Address - Phone:843-454-2294
Mailing Address - Fax:843-454-2342
Practice Address - Street 1:1076 MARLBORO WAY
Practice Address - Street 2:SUITE 1
Practice Address - City:BENNETTSVILLE
Practice Address - State:SC
Practice Address - Zip Code:29512-2495
Practice Address - Country:US
Practice Address - Phone:843-454-2294
Practice Address - Fax:843-454-2342
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2017-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC0360207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC0204147OtherGHI/PPO
NC89065X7Medicaid
SC003604Medicaid
SC407690OtherWELLCARE
SC000000157262OtherUNISON
SC5953112OtherAETNA
SC$$$$$$$$$OtherBCBS
SCF225315345Medicare PIN
SC$$$$$$$$$OtherBCBS
SC5953112OtherAETNA
NC89065X7Medicaid