Provider Demographics
NPI:1447292941
Name:VAIL, CYNTHIA S (PA-C)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:S
Last Name:VAIL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:607 BEAMAN ST
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:NC
Mailing Address - Zip Code:28328
Mailing Address - Country:US
Mailing Address - Phone:910-592-8511
Mailing Address - Fax:802-872-0282
Practice Address - Street 1:301 MAIN ST
Practice Address - Street 2:
Practice Address - City:NEWTON GROVE
Practice Address - State:NC
Practice Address - Zip Code:28366
Practice Address - Country:US
Practice Address - Phone:910-594-0003
Practice Address - Fax:802-872-0282
Is Sole Proprietor?:No
Enumeration Date:2006-06-11
Last Update Date:2016-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPA-657363A00000X
NC363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME269220099Medicaid
MEAP1449Medicare PIN
ME269220099Medicaid