Provider Demographics
NPI:1114023710
Name:CERNICA-REICHARD, MARY SARAH (DPM)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:SARAH
Last Name:CERNICA-REICHARD
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7229 TRENHOLM RD
Mailing Address - Street 2:
Mailing Address - City:BOARDMAN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-4743
Mailing Address - Country:US
Mailing Address - Phone:330-550-9811
Mailing Address - Fax:
Practice Address - Street 1:1300 S CANFIELD NILES RD
Practice Address - Street 2:SUITE 1
Practice Address - City:AUSTINTOWN
Practice Address - State:OH
Practice Address - Zip Code:44515-4081
Practice Address - Country:US
Practice Address - Phone:330-792-6519
Practice Address - Fax:330-792-9911
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2008-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36.003434213EP1101X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000497906OtherANTHEMBCBS
OH2687356Medicaid
OHU36983Medicare UPIN
OH4196282Medicare PIN
OH4196283Medicare PIN
OH4196281Medicare PIN