Provider Demographics
NPI:1104883552
Name:COLVEN, CYNTHIA WOODSON (MD)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:WOODSON
Last Name:COLVEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CYNTHIA
Other - Middle Name:ANNE
Other - Last Name:WOODSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1404 NE 134TH ST
Mailing Address - Street 2:#170
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98685-2799
Mailing Address - Country:US
Mailing Address - Phone:360-573-1381
Mailing Address - Fax:360-573-1384
Practice Address - Street 1:1404 NE 134TH ST
Practice Address - Street 2:#170
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98685-2799
Practice Address - Country:US
Practice Address - Phone:360-573-1381
Practice Address - Fax:360-573-1384
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2008-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00032812207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1122076Medicaid
WA1122076Medicaid
F77018Medicare UPIN