Healthcare Provider Details

I. General information

NPI: 1023017506
Provider Name (Legal Business Name): CINDY CRITTENDON DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2005
Last Update Date: 09/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1076 MARLBORO WAY SUITE 1
BENNETTSVILLE SC
29512-2495
US

IV. Provider business mailing address

1076 MARLBORO WAY SUITE 1
BENNETTSVILLE SC
29512-2495
US

V. Phone/Fax

Practice location:
  • Phone: 843-454-2294
  • Fax: 843-454-2342
Mailing address:
  • Phone: 843-454-2294
  • Fax: 843-454-2342

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number0360
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: