Provider Demographics
NPI:1962581058
Name:CAMPBELL, CYNTHIA GRANT (MD)
Entity type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:GRANT
Last Name:CAMPBELL
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 1:500 17TH AVE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98122-5711
Mailing Address - Country:US
Mailing Address - Phone:206-320-2492
Mailing Address - Fax:206-320-4073
Practice Address - Street 1:500 17TH AVE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98122-5711
Practice Address - Country:US
Practice Address - Phone:206-320-2492
Practice Address - Fax:206-320-4073
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2011-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00020983208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1043967Medicaid
WA00081OtherL&I
WA1043967Medicaid
WA00081OtherL&I