Healthcare Provider Details

I. General information

NPI: 1558476168
Provider Name (Legal Business Name): CYNTHIA ANN DE MEESTER M.D., PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 11/25/2024
Certification Date: 11/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

260 NEW LUDLOW RD
CHICOPEE MA
01020-4324
US

IV. Provider business mailing address

71 HARTWELL RD
WEST HARTFORD CT
06117-1912
US

V. Phone/Fax

Practice location:
  • Phone: 413-533-3470
  • Fax: 413-533-6859
Mailing address:
  • Phone: 805-680-7672
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number100930
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2022009603
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberG86497
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: