MEDICARE: CYNTHIA ANN DE MEESTER M.D., PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	100930	WI
2	208000000X	Pediatrics Physician	2022009603	MO
3	208000000X	Pediatrics Physician	G86497	CA

General Provider Information

NPI Number	:	1558476168
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CYNTHIA ANN DE MEESTER M.D., PH.D.

Provider Business Mailing Address
First Line	:	71 HARTWELL RD
Second Line	:
City	:	WEST HARTFORD
State	:	CT
Zip	:	06117-1912
Country	:	US
Telephone Number	:	805-680-7672
Fax Number	:

Provider Business Practice Location Address
First Line	:	260 NEW LUDLOW RD
Second Line	:
City	:	CHICOPEE
State	:	MA
Zip	:	01020-4324
Country	:	US
Telephone Number	:	413-533-3470
Fax Number	:	413-533-6859

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/21/2006
Last Update Date	:	11/25/2024

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