Provider Demographics
NPI:1740312784
Name:CYNTHIA PADDEN STODDARD, MD, PS
Entity type:Organization
Organization Name:CYNTHIA PADDEN STODDARD, MD, PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:PADDEN
Authorized Official - Last Name:STODDARD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:206-683-9133
Mailing Address - Street 1:511 N 65TH ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-5301
Mailing Address - Country:US
Mailing Address - Phone:206-781-8114
Mailing Address - Fax:206-783-0386
Practice Address - Street 1:6417 PHINNEY AVE N
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-5517
Practice Address - Country:US
Practice Address - Phone:206-782-6463
Practice Address - Fax:206-782-6465
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000411872084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1063515278OtherNPI FOR INDIVIDUAL
WA1118066Medicaid
WA8322323Medicaid
WAH91913Medicare UPIN
WA8858899Medicare ID - Type UnspecifiedID FOR PSNHC CLINIC
WA1063515278OtherNPI FOR INDIVIDUAL
WA8322323Medicaid