Provider Demographics
NPI:1962401091
Name:PASCUAL, CYNTHIA LYNN (MD)
Entity type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:LYNN
Last Name:PASCUAL
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 1:3245 HEALTH DR STE 100
Mailing Address - Street 2:
Mailing Address - City:GRANGER
Mailing Address - State:IN
Mailing Address - Zip Code:46530-1380
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12340 BITTERSWEET COMMONS BLVD W
Practice Address - Street 2:
Practice Address - City:GRANGER
Practice Address - State:IN
Practice Address - Zip Code:46530-6959
Practice Address - Country:US
Practice Address - Phone:574-271-8610
Practice Address - Fax:574-271-8620
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301116513207Q00000X
IN01054944A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1962401091Medicaid
IN200343500Medicaid
IN236040078OtherMEDICARE
IN000000664911OtherANTHEM - FMC
F15278Medicare UPIN
080174534 RR MED #Medicare PIN