Provider Demographics
NPI:1194832105
Name:CHERIYATH, PRAMIL (MD)
Entity Type:Individual
Prefix:DR
First Name:PRAMIL
Middle Name:
Last Name:CHERIYATH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:409 S 2ND ST
Mailing Address - Street 2:SUITE 2F
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17104-1612
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:810 SIR THOMAS CT
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17109-4839
Practice Address - Country:US
Practice Address - Phone:717-614-4420
Practice Address - Fax:717-614-4421
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2016-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD429394207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAP00378527OtherRAILROAD MEDICARE
PA101692998Medicaid
PA190378OtherUNISON/THREE RIVERS
PA500061561OtherBLUE CROSS
PAMD429394OtherSTATE LICENSE
PA1883437OtherHI9GHMARK BLUE SHIELD
PA190378OtherUNISON/THREE RIVERS