Provider Demographics
NPI:1457425100
Name:MCCRAVEN, CYNTHIA HALL (MD)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:HALL
Last Name:MCCRAVEN
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 1:863 N MAIN STREET EXT STE 301
Mailing Address - Street 2:
Mailing Address - City:WALLINGFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06492-2434
Mailing Address - Country:US
Mailing Address - Phone:203-269-0885
Mailing Address - Fax:
Practice Address - Street 1:863 N MAIN STREET EXT STE 301
Practice Address - Street 2:
Practice Address - City:WALLINGFORD
Practice Address - State:CT
Practice Address - Zip Code:06492-2434
Practice Address - Country:US
Practice Address - Phone:203-269-0885
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2018-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT030434207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT4124033OtherAETNA
CT304340OtherCONNECTICARE
CTP1024514OtherOXFORD
CT0V0941OtherHEALTHNET
CT010030434CT01OtherBLUE SHIELD
CT98525OtherCIGNA
CTE66257Medicare UPIN