Healthcare Provider Details

I. General information

NPI: 1790786069
Provider Name (Legal Business Name): CYNTHIA SPAULDING M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 05/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 MARTHA JEFFERSON DRIVE
CHARLOTTESVILLE VA
22911-4668
US

IV. Provider business mailing address

2864 JOHNSON FERRY RD SUITE 150
MARIETTA GA
30062-5635
US

V. Phone/Fax

Practice location:
  • Phone: 434-654-8125
  • Fax: 434-654-8127
Mailing address:
  • Phone: 770-693-2622
  • Fax: 770-693-6039

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number0101038684
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: