MEDICARE: CYNTHIA C BERWALD PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	4948359-1206	UT

General Provider Information

NPI Number	:	1033117874
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CYNTHIA C BERWALD PA

Provider Business Mailing Address
First Line	:	PO BOX 27128
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84127-0128
Country	:	US
Telephone Number	:	435-940-9400
Fax Number	:

Provider Business Practice Location Address
First Line	:	2720 HOMESTEAD RD
Second Line	:	SUITE 100
City	:	PARK CITY
State	:	UT
Zip	:	84098-4881
Country	:	US
Telephone Number	:	435-940-9400
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/13/2005
Last Update Date	:	09/16/2021

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Directions to “ CYNTHIA C BERWALD PA” Practice Location

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