Basic Information
| Provider Information | |||||||||
| NPI: | 1861525149 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DUGAN | ||||||||
| FirstName: | CINDY | ||||||||
| MiddleName: | CONSTANTINO | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1124 WINDSOR DR. | ||||||||
| Address2: | |||||||||
| City: | MINERAL WELLS | ||||||||
| State: | WV | ||||||||
| PostalCode: | 26150 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3044893067 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 184 HOLIDAY HILLS DR | ||||||||
| Address2: | |||||||||
| City: | PARKERSBURG | ||||||||
| State: | WV | ||||||||
| PostalCode: | 261048006 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3044851721 | ||||||||
| FaxNumber: | 3044856710 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/14/2007 | ||||||||
| LastUpdateDate: | 03/17/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | 20322 | WV | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | 20322 | 01 | WV | MEDICAL LICENSE | OTHER | BC5241752 | 01 | WV | DEA CERTIFICATE | OTHER |