Basic Information
| Provider Information | |||||||||
| NPI: | 1487847935 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PRITCHETT | ||||||||
| FirstName: | CYNARO | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7385 STATE ROUTE 3 | ||||||||
| Address2: | UNIT 54 | ||||||||
| City: | WESTERVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 430828654 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4843489486 | ||||||||
| FaxNumber: | 2535632155 | ||||||||
| Practice Location | |||||||||
| Address1: | 5175 E MAIN ST | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432132425 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6145751200 | ||||||||
| FaxNumber: | 6145759405 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/18/2007 | ||||||||
| LastUpdateDate: | 03/13/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 35069666 | OH | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0203210 | 05 | OH | MEDICAID |