Provider Demographics
NPI:1164634341
Name:FLYNN, CHERYL A (MD)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:A
Last Name:FLYNN
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 1:425 PEARL ST
Mailing Address - Street 2:UVM CHWB
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05401-3308
Mailing Address - Country:US
Mailing Address - Phone:802-656-3350
Mailing Address - Fax:
Practice Address - Street 1:425 PEARL ST
Practice Address - Street 2:UVM CHWB
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-3308
Practice Address - Country:US
Practice Address - Phone:802-656-3350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2011-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY00212104208D00000X
VT042-0012141207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01881332Medicaid
NYG10014Medicare UPIN