Provider Demographics
NPI:1316017270
Name:NAVARRO-MCGUINNESS, CHERYL TAN (DO)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:TAN
Last Name:NAVARRO-MCGUINNESS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 602148
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-2148
Mailing Address - Country:US
Mailing Address - Phone:704-663-4443
Mailing Address - Fax:704-663-6999
Practice Address - Street 1:137 PROFESSIONAL PARK DR
Practice Address - Street 2:SUITE A
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-6540
Practice Address - Country:US
Practice Address - Phone:704-663-4443
Practice Address - Fax:704-663-6999
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2014-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2006-01750207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1316017270Medicaid
NCNCF400BMedicare PIN