Provider Demographics
NPI:1295835742
Name:CERNY, EVA E (MD)
Entity Type:Individual
Prefix:DR
First Name:EVA
Middle Name:E
Last Name:CERNY
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 1:1177B SOUTH GOVERNORS AVE
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19904
Mailing Address - Country:US
Mailing Address - Phone:302-674-8441
Mailing Address - Fax:302-674-8469
Practice Address - Street 1:1177B S GOVERNORS AVE
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19904-6903
Practice Address - Country:US
Practice Address - Phone:302-674-8441
Practice Address - Fax:302-674-8469
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2010-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC10002054207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
136J59OtherBC
DE0000089401Medicaid
404942Medicare ID - Type Unspecified
136J59OtherBC