Provider Demographics
NPI:1366468258
Name:CHERULLO, EDWARD E (MD)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:E
Last Name:CHERULLO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24701 EUCLID AVE
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44117-1714
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11100 EUCLID AVENUE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106
Practice Address - Country:US
Practice Address - Phone:216-844-5661
Practice Address - Fax:216-286-6341
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2012-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35076248208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000503663OtherANTHEM
OH741764OtherBUCKEYE
OHP00255731OtherRAILROAD MEDICARE
OHP00388790OtherRAILROAD MEDICARE
OH000000210266OtherUNISON
OH2564416Medicaid
OH363419OtherWELLCARE
OH7411480OtherAETNA
OHP00255731OtherRAILROAD MEDICARE
OH7411480OtherAETNA
OH2564416Medicaid