Healthcare Provider Details

I. General information

NPI: 1043300502
Provider Name (Legal Business Name): CYNTHIA ANN GINGALEWSKI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 12/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 N GRAHAM ST MOB 2 SUITE 300
PORTLAND OR
97227-1654
US

IV. Provider business mailing address

501 N GRAHAM ST MOB 2 SUITE 300
PORTLAND OR
97227-1654
US

V. Phone/Fax

Practice location:
  • Phone: 503-413-4300
  • Fax:
Mailing address:
  • Phone: 503-413-4300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0120X
TaxonomyPediatric Surgery Physician
License NumberMD035632
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code2086S0120X
TaxonomyPediatric Surgery Physician
License NumberMD161804
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: