Provider Demographics
NPI:1912067513
Name:JOSEPH, CYNTHIA J (MD)
Entity Type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:J
Last Name:JOSEPH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:CYNTHIA
Other - Middle Name:JOSEPH
Other - Last Name:KOENIG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2101 EAST JEFFERSON STREET
Mailing Address - Street 2:PPQA MEDICARE COMPLIANCE UNIT 6 WEST
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-4908
Mailing Address - Country:US
Mailing Address - Phone:301-816-6660
Mailing Address - Fax:301-816-6308
Practice Address - Street 1:12201 PLUM ORCHARD DRIVE
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-7803
Practice Address - Country:US
Practice Address - Phone:301-572-3305
Practice Address - Fax:301-572-3398
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD36333208000000X
DCMD17220208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
034308M92Medicare ID - Type Unspecified
C79107Medicare UPIN