Provider Demographics
NPI:1194863324
Name:SMITH, CHERYL E (MD PC)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:E
Last Name:SMITH
Suffix:
Gender:F
Credentials:MD PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 EAST HIGH STREET
Mailing Address - Street 2:SUITE F
Mailing Address - City:GLASSBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08028-2595
Mailing Address - Country:US
Mailing Address - Phone:856-881-0665
Mailing Address - Fax:856-881-1449
Practice Address - Street 1:15 EAST HIGH STREET
Practice Address - Street 2:SUITE F
Practice Address - City:GLASSBORO
Practice Address - State:NJ
Practice Address - Zip Code:08028-2595
Practice Address - Country:US
Practice Address - Phone:609-868-4906
Practice Address - Fax:856-881-1449
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04238400207ZD0900X, 207ZH0000X, 207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207ZD0900XAllopathic & Osteopathic PhysiciansPathologyDermatopathology
Not Answered207ZH0000XAllopathic & Osteopathic PhysiciansPathologyHematology
Not Answered207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2392704Medicaid
0108553000OtherAMERIHEALTH AND KEYSTONE
35552OtherAETNA USHC
D19221Medicare UPIN
35552OtherAETNA USHC