Provider Demographics
NPI:1346256963
Name:HLAVAC, CHERYL A (MD)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:A
Last Name:HLAVAC
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 MCFARLAN RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:KENNETT SQUARE
Mailing Address - State:PA
Mailing Address - Zip Code:19348-2453
Mailing Address - Country:US
Mailing Address - Phone:610-444-5678
Mailing Address - Fax:610-444-1738
Practice Address - Street 1:402 MCFARLAN RD
Practice Address - Street 2:SUITE 102
Practice Address - City:KENNETT SQUARE
Practice Address - State:PA
Practice Address - Zip Code:19348-2453
Practice Address - Country:US
Practice Address - Phone:614-444-5678
Practice Address - Fax:614-444-1738
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2013-05-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD033944E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001104977Medicaid
PA001104977Medicaid
PA189889Medicare PIN