Healthcare Provider Details

I. General information

NPI: 1649290693
Provider Name (Legal Business Name): CYNTHIA EVANS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 04/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

422 E MCPHERSON HWY SUITE A
CLYDE OH
43410-1257
US

IV. Provider business mailing address

PO BOX 636741
CINCINNATI OH
45263-0001
US

V. Phone/Fax

Practice location:
  • Phone: 419-626-6161
  • Fax:
Mailing address:
  • Phone: 419-609-1112
  • Fax: 419-609-1123

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number35-045532
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: