1326015710 NPI number — MRS. CYNTHIA MATHEWSON OLIVACZ P.T.

Table of content: MRS. CYNTHIA MATHEWSON OLIVACZ P.T. (NPI 1326015710)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326015710 NPI number — MRS. CYNTHIA MATHEWSON OLIVACZ P.T.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OLIVACZ
Provider First Name:
CYNTHIA
Provider Middle Name:
MATHEWSON
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
P.T.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MATHEWSON
Provider Other First Name:
CYNTHIA
Provider Other Middle Name:
LEE
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
P.T.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1326015710
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
701 REVOLUTION ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HAVRE DE GRACE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21078-3321
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-939-4334
Provider Business Mailing Address Fax Number:
410-939-0530

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
701 REVOLUTION ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HAVRE DE GRACE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21078-3321
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-939-4334
Provider Business Practice Location Address Fax Number:
410-939-0530
Provider Enumeration Date:
03/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  19815 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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