Healthcare Provider Details

I. General information

NPI: 1831168574
Provider Name (Legal Business Name): CYLBURN EARL SODEN SR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2006
Last Update Date: 08/07/2008
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: 301-776-0743
  • Fax: 301-776-0456
Mailing address:
  • Phone: 301-776-0743
  • Fax: 301-776-0456

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberD0024150
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: