Healthcare Provider Details

I. General information

NPI: 1184745374
Provider Name (Legal Business Name): CYNTHIA CAROL MOBLEY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1374 W NORTH AVE
BALTIMORE MD
21217-3536
US

IV. Provider business mailing address

3601 CROSSLAND AVE
BALTIMORE MD
21213-1006
US

V. Phone/Fax

Practice location:
  • Phone: 410-396-0063
  • Fax: 410-669-0071
Mailing address:
  • Phone: 410-889-0884
  • Fax: 410-669-0071

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD0040332
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: