Healthcare Provider Details

I. General information

NPI: 1033378260
Provider Name (Legal Business Name): CYNTHIA ANN FANNON AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2008
Last Update Date: 12/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6565 N CHARLES ST SUITE 601
BALTIMORE MD
21204-6800
US

IV. Provider business mailing address

6565 N CHARLES ST SUITE 601
BALTIMORE MD
21204-6800
US

V. Phone/Fax

Practice location:
  • Phone: 410-821-5151
  • Fax:
Mailing address:
  • Phone: 410-821-5151
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number01151
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: