Provider Demographics
NPI:1154318210
Name:SKINNER, CHERYL ANN (MD)
Entity Type:Individual
Prefix:DR
First Name:CHERYL
Middle Name:ANN
Last Name:SKINNER
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 1:842 CARSON DR
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:OH
Mailing Address - Zip Code:45036-1316
Mailing Address - Country:US
Mailing Address - Phone:513-325-4392
Mailing Address - Fax:
Practice Address - Street 1:100 ARROW SPRINGS BLVD
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:OH
Practice Address - Zip Code:45036-7002
Practice Address - Country:US
Practice Address - Phone:513-451-4033
Practice Address - Fax:513-451-1356
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-04
Last Update Date:2019-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35048340174400000X, 207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0636217Medicaid
OH0386959Medicare PIN
OH0636217Medicaid
OHH068261Medicare PIN
OH0587613Medicare PIN
OH0587614Medicare UPIN
OH7367321Medicare PIN
OHLE9374271Medicare PIN