Provider Demographics
NPI:1124078217
Name:HADLEY, CYNTHIA (MD)
Entity type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:
Last Name:HADLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2134 KILKEE DR
Mailing Address - Street 2:
Mailing Address - City:CALABASH
Mailing Address - State:NC
Mailing Address - Zip Code:28467-1759
Mailing Address - Country:US
Mailing Address - Phone:585-259-6433
Mailing Address - Fax:
Practice Address - Street 1:2134 KILKEE DR
Practice Address - Street 2:
Practice Address - City:CALABASH
Practice Address - State:NC
Practice Address - Zip Code:28467-1759
Practice Address - Country:US
Practice Address - Phone:585-259-6433
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2013-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY177852207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01200182Medicaid
NYB59759Medicare UPIN
NYBB4169Medicare PIN
NY080131056Medicare PIN