Provider Demographics
NPI:1366560880
Name:FAN, XINHAO CYNTHIA (MD)
Entity type:Individual
Prefix:DR
First Name:XINHAO
Middle Name:CYNTHIA
Last Name:FAN
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:55 SPINDRIFT DR
Mailing Address - Street 2:WINDSONG RADIOLOGY GROUP, P.C.
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-7800
Mailing Address - Country:US
Mailing Address - Phone:716-631-2500
Mailing Address - Fax:716-631-1249
Practice Address - Street 1:55 SPINDRIFT DR
Practice Address - Street 2:WINDSONG RADIOLOGY GROUP, P.C.
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-7800
Practice Address - Country:US
Practice Address - Phone:716-631-2500
Practice Address - Fax:716-631-1249
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2014-03-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI43010797232085D0003X, 390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085D0003XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Neuroimaging
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY2115194OtherIHA
NY080624000030OtherFIDELIS
NY000530194001OtherWNY BSBC
NY02972067Medicaid
NY00028479101OtherUNIVERA
NY02972067Medicaid