Healthcare Provider Details

I. General information

NPI: 1386107639
Provider Name (Legal Business Name): CYNTHIA JOSEPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2019
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

575 RILEY HOSPITAL DR
INDIANAPOLIS IN
46202-5272
US

IV. Provider business mailing address

PO BOX 719094
CHICAGO IL
60677-9318
US

V. Phone/Fax

Practice location:
  • Phone: 317-944-2143
  • Fax:
Mailing address:
  • Phone: 317-777-6435
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License Number01100436A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: