Provider Demographics
NPI:1316909039
Name:BAMFORD, CYNTHIA (MD)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:
Last Name:BAMFORD
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:PO BOX 92168
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44191-2168
Mailing Address - Country:US
Mailing Address - Phone:888-328-4472
Mailing Address - Fax:
Practice Address - Street 1:13 W EXCHANGE ST
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44308-1012
Practice Address - Country:US
Practice Address - Phone:330-376-1902
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350622242084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0164941Medicaid
OH728978OtherBUCKEYE COMMUNITY HEALTH
OH56992OtherQUALCHOICE
OH000000324689OtherANTHEM BLUECROSS/BLUESHEI
OHP00140812OtherRAILROAD MEDICARE
OH728978OtherBUCKEYE COMMUNITY HEALTH
OH56992OtherQUALCHOICE
OHG09257Medicare UPIN