Healthcare Provider Details

I. General information

NPI: 1841294204
Provider Name (Legal Business Name): CYNTHIA A BRIGLIN-MAVADY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2005
Last Update Date: 04/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

194 GRANDVIEW LN
NORWICH NY
13815-3331
US

IV. Provider business mailing address

194 GRANDVIEW LN
NORWICH NY
13815-3331
US

V. Phone/Fax

Practice location:
  • Phone: 607-334-3225
  • Fax: 607-334-5946
Mailing address:
  • Phone: 607-334-3225
  • Fax: 607-334-5946

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number199803
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: