Provider Demographics
NPI:1316930779
Name:HANAWALT, CINDY L (MD, PHD, MS)
Entity type:Individual
Prefix:DR
First Name:CINDY
Middle Name:L
Last Name:HANAWALT
Suffix:
Gender:F
Credentials:MD, PHD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 NATIONWIDE DR
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24502-4272
Mailing Address - Country:US
Mailing Address - Phone:434-200-6933
Mailing Address - Fax:
Practice Address - Street 1:125 NATIONWIDE DR
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24502-4272
Practice Address - Country:US
Practice Address - Phone:434-200-6933
Practice Address - Fax:434-200-6933
Is Sole Proprietor?:No
Enumeration Date:2005-08-31
Last Update Date:2024-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA34383207Q00000X
VA01012813182083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA15689OtherWELLMARK BCBS OF IOWA
IA0076372Medicaid
IA4212837Medicaid
I9336Medicare ID - Type Unspecified
IA4212837Medicaid