MEDICARE: MRS. CYNTHIA WHITE

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	246ZA2600X	Medical Art Specialist/Technologist

General Provider Information

NPI Number	:	1619610359
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CYNTHIA WHITE

Provider Business Mailing Address
First Line	:	13035 MARQUETTE LN
Second Line	:
City	:	BOWIE
State	:	MD
Zip	:	20715-3027
Country	:	US
Telephone Number	:	202-316-2465
Fax Number	:

Provider Business Practice Location Address
First Line	:	4331 GALLATIN ST STE 201B
Second Line	:
City	:	HYATTSVILLE
State	:	MD
Zip	:	20781-2022
Country	:	US
Telephone Number	:	202-316-2465
Fax Number	:

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

Provider Enumeration Date	:	04/20/2022
Last Update Date	:	04/20/2022

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Directions to “ MRS. CYNTHIA WHITE ” Practice Location

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