Provider Demographics
NPI:1649260233
Name:MAYFIELD, CYNTHIA E (MD)
Entity type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:E
Last Name:MAYFIELD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2102 E INWOOD RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46614-2443
Mailing Address - Country:US
Mailing Address - Phone:574-299-2400
Mailing Address - Fax:574-299-2410
Practice Address - Street 1:2102 E INWOOD RD
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46614-2443
Practice Address - Country:US
Practice Address - Phone:574-299-2400
Practice Address - Fax:574-299-2410
Is Sole Proprietor?:No
Enumeration Date:2005-10-25
Last Update Date:2016-08-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN01039573A207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100092010Medicaid
IN100092010Medicaid
INE93635Medicare UPIN