Provider Demographics
NPI:1831354521
Name:CYNKUTIS-SIMON, MAGDALENA MARIA (MD)
Entity type:Individual
Prefix:MRS
First Name:MAGDALENA
Middle Name:MARIA
Last Name:CYNKUTIS-SIMON
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 1:3750 CHEMAWA RD NE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97305-1111
Mailing Address - Country:US
Mailing Address - Phone:503-304-7600
Mailing Address - Fax:503-304-7677
Practice Address - Street 1:3750 CHEMAWA RD NE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97305-1111
Practice Address - Country:US
Practice Address - Phone:503-304-7600
Practice Address - Fax:503-304-7677
Is Sole Proprietor?:No
Enumeration Date:2008-07-23
Last Update Date:2012-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00045438207Q00000X, 171W00000X
CAA93711171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine