Healthcare Provider Details

I. General information

NPI: 1316930779
Provider Name (Legal Business Name): CINDY L HANAWALT MD, PHD, MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2005
Last Update Date: 06/28/2024
Certification Date: 06/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 NATIONWIDE DR
LYNCHBURG VA
24502-4272
US

IV. Provider business mailing address

125 NATIONWIDE DR
LYNCHBURG VA
24502-4272
US

V. Phone/Fax

Practice location:
  • Phone: 434-200-6933
  • Fax: 434-200-6933
Mailing address:
  • Phone: 434-200-6933
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number34383
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number0101281318
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: