Provider Demographics
NPI:1427256668
Name:BACKUS, CYNTHIA RITA (MLT (ASCP)#34612)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:RITA
Last Name:BACKUS
Suffix:
Gender:F
Credentials:MLT (ASCP)#34612
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1135 THISTLE GOLD DR
Mailing Address - Street 2:
Mailing Address - City:HOPE MILLS
Mailing Address - State:NC
Mailing Address - Zip Code:28348-9096
Mailing Address - Country:US
Mailing Address - Phone:910-868-9279
Mailing Address - Fax:
Practice Address - Street 1:WOMAC ARMY MEDICAL HOSPITAL
Practice Address - Street 2:
Practice Address - City:FORT BRAGG
Practice Address - State:NC
Practice Address - Zip Code:28310-0001
Practice Address - Country:US
Practice Address - Phone:910-907-9305
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-10
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34612246RM2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RM2200XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyMedical Laboratory