Provider Demographics
NPI:1306974845
Name:SHORT, CYNTHIA LARRABEE (MD)
Entity type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:LARRABEE
Last Name:SHORT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:79 NORTH ST
Mailing Address - Street 2:
Mailing Address - City:GRANVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12832-1137
Mailing Address - Country:US
Mailing Address - Phone:518-642-0612
Mailing Address - Fax:518-642-0693
Practice Address - Street 1:79 NORTH ST
Practice Address - Street 2:
Practice Address - City:GRANVILLE
Practice Address - State:NY
Practice Address - Zip Code:12832-1137
Practice Address - Country:US
Practice Address - Phone:518-642-0612
Practice Address - Fax:518-642-0693
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY171757207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine