Provider Demographics
NPI:1770675670
Name:ST. ONGE, CINDY LEE (MD)
Entity type:Individual
Prefix:DR
First Name:CINDY
Middle Name:LEE
Last Name:ST. ONGE
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 1:44 DALE RD
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:CT
Mailing Address - Zip Code:06001-3612
Mailing Address - Country:US
Mailing Address - Phone:860-678-0484
Mailing Address - Fax:860-678-1454
Practice Address - Street 1:44 DALE RD
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:CT
Practice Address - Zip Code:06001-3612
Practice Address - Country:US
Practice Address - Phone:860-678-0484
Practice Address - Fax:860-678-1454
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT036295208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTG59809Medicare UPIN