Provider Demographics
NPI:1487606612
Name:WILBERDING, CYNTHIA A (MD)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:A
Last Name:WILBERDING
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1259
Mailing Address - Street 2:SENTINEL HEALTH PARTNERS PA
Mailing Address - City:CAMDEN
Mailing Address - State:SC
Mailing Address - Zip Code:29021
Mailing Address - Country:US
Mailing Address - Phone:803-713-8350
Mailing Address - Fax:803-713-8433
Practice Address - Street 1:216 E MARION ST
Practice Address - Street 2:
Practice Address - City:KERSHAW
Practice Address - State:SC
Practice Address - Zip Code:29067-1442
Practice Address - Country:US
Practice Address - Phone:803-475-3475
Practice Address - Fax:803-475-5360
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2012-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC19663207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC99648OtherMEDCOST PIN
SC110206712OtherRAILROAD MEDICARE PIN
SCN07094Medicaid
SCN07094Medicaid
SCA752636286Medicare PIN