Healthcare Provider Details

I. General information

NPI: 1346337524
Provider Name (Legal Business Name): CYNDRA RENEE MOGAYZEL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1912 MANOR GROVE RD
ANNAPOLIS MD
21401-2947
US

IV. Provider business mailing address

1912 MANOR GROVE RD
ANNAPOLIS MD
21401-2947
US

V. Phone/Fax

Practice location:
  • Phone: 410-841-1991
  • Fax:
Mailing address:
  • Phone: 410-841-1991
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD0046236
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: