Provider Demographics
NPI:1215964325
Name:RICHARDS, CYNTHIA WILSON (MD)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:WILSON
Last Name:RICHARDS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CYNTHIA
Other - Middle Name:WILSON
Other - Last Name:MAJERSKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 64575
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28306-0575
Mailing Address - Country:US
Mailing Address - Phone:910-630-1112
Mailing Address - Fax:910-425-1110
Practice Address - Street 1:1540 PURDUE DR
Practice Address - Street 2:STE. 200
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28303-5509
Practice Address - Country:US
Practice Address - Phone:910-630-1112
Practice Address - Fax:910-425-1110
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2019-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMD16782208100000X
ME016782208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation