Healthcare Provider Details

I. General information

NPI: 1366560880
Provider Name (Legal Business Name): XINHAO CYNTHIA FAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 03/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 SPINDRIFT DR WINDSONG RADIOLOGY GROUP, P.C.
WILLIAMSVILLE NY
14221-7800
US

IV. Provider business mailing address

55 SPINDRIFT DR WINDSONG RADIOLOGY GROUP, P.C.
WILLIAMSVILLE NY
14221-7800
US

V. Phone/Fax

Practice location:
  • Phone: 716-631-2500
  • Fax: 716-631-1249
Mailing address:
  • Phone: 716-631-2500
  • Fax: 716-631-1249

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number4301079723
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code2085D0003X
TaxonomyDiagnostic Neuroimaging (Radiology) Physician
License Number4301079723
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: