Healthcare Provider Details

I. General information

NPI: 1598958084
Provider Name (Legal Business Name): CYLBURN E SODEN M.D.P.A
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2007
Last Update Date: 08/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13920 BALTIMORE AVE
LAUREL MD
20707-5009
US

IV. Provider business mailing address

13920 BALTIMORE AVE
LAUREL MD
20707-5009
US

V. Phone/Fax

Practice location:
  • Phone: 301-776-1094
  • Fax: 301-776-0456
Mailing address:
  • Phone: 301-776-1094
  • Fax: 301-776-0456

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberD0024150
License Number StateMD

VIII. Authorized Official

Name: MRS. VIRGINIA DORIS SODEN
Title or Position: PRACTICE MANAGER
Credential: R.N.,M.S.
Phone: 301-776-1094