Provider Demographics
NPI:1831108778
Name:PANOWICZ, CYNTHIA ANN (MD)
Entity type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:ANN
Last Name:PANOWICZ
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:PO BOX 890588
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28289-0588
Mailing Address - Country:US
Mailing Address - Phone:828-288-3993
Mailing Address - Fax:828-288-3955
Practice Address - Street 1:162 COMMERCIAL ST
Practice Address - Street 2:SUITE B
Practice Address - City:FOREST CITY
Practice Address - State:NC
Practice Address - Zip Code:28043-2849
Practice Address - Country:US
Practice Address - Phone:828-287-9325
Practice Address - Fax:828-287-3594
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2014-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9600670208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8964948Medicaid
NC64948OtherBCBS
G27201Medicare UPIN