Provider Demographics
NPI:1548261043
Name:MUELLER, CYNTHIA JANE (MD)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:JANE
Last Name:MUELLER
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 1:58 16TH ST
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-3660
Mailing Address - Country:US
Mailing Address - Phone:304-234-2003
Mailing Address - Fax:304-234-2006
Practice Address - Street 1:58 16TH ST
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003-3660
Practice Address - Country:US
Practice Address - Phone:304-234-2003
Practice Address - Fax:304-234-2006
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV18528207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV55035705701OtherWV COMPENSATION
5503570579A49OtherANTHEM BCBS
18528OtherHEALTH PLAN OF UPPER OH V
OH0225938Medicaid
WV0054509000Medicaid
OH0225938Medicaid
WV7230881Medicare ID - Type Unspecified