Basic Information
| Provider Information | |||||||||
| NPI: | 1316909039 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BAMFORD | ||||||||
| FirstName: | CYNTHIA | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 92168 | ||||||||
| Address2: | |||||||||
| City: | CLEVELAND | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441912168 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8883284472 | ||||||||
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| Practice Location | |||||||||
| Address1: | 13 W EXCHANGE ST | ||||||||
| Address2: | |||||||||
| City: | AKRON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 443081012 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3303761902 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/06/2006 | ||||||||
| LastUpdateDate: | 07/09/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084N0400X | 35062224 | OH | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology |
ID Information
| ID | Type | State | Issuer | Description | 0164941 | 05 | OH | MEDICAID | 728978 | 01 | OH | BUCKEYE COMMUNITY HEALTH | OTHER | 56992 | 01 | OH | QUALCHOICE | OTHER | 000000324689 | 01 | OH | ANTHEM BLUECROSS/BLUESHEI | OTHER | P00140812 | 01 | OH | RAILROAD MEDICARE | OTHER |