Healthcare Provider Details

I. General information

NPI: 1801966593
Provider Name (Legal Business Name): CYNTHIA A SMITH-SEIDEL PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 07/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1708 W ROGERS AVE
BALTIMORE MD
21209-4545
US

IV. Provider business mailing address

5051 GREENSPRING AVE SUITE300
BALTIMORE MD
21209-4354
US

V. Phone/Fax

Practice location:
  • Phone: 410-578-8600
  • Fax:
Mailing address:
  • Phone: 410-601-7351
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number03713
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: