Provider Demographics
NPI:1346241874
Name:ENTRESS, CHERYL P (MD)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:P
Last Name:ENTRESS
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 1:58 16TH ST
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-3660
Mailing Address - Country:US
Mailing Address - Phone:304-234-2116
Mailing Address - Fax:304-234-2030
Practice Address - Street 1:58 16TH ST
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003-3660
Practice Address - Country:US
Practice Address - Phone:304-234-2116
Practice Address - Fax:304-234-2030
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV09089207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0779644Medicaid
5503570579J26OtherANTHEM BCBS
WV0055318000Medicaid
09089DOtherHEALTH PLAN OF UPPER OH V
WV55035705705OtherWV COMPENSATION
WV55035705705OtherWV COMPENSATION
09089DOtherHEALTH PLAN OF UPPER OH V