Provider Demographics
NPI:1386628469
Name:CHERNICK, ANDREW R (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:R
Last Name:CHERNICK
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 1:999 GARDEN RD
Mailing Address - Street 2:
Mailing Address - City:ZANESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43701-1330
Mailing Address - Country:US
Mailing Address - Phone:740-454-8193
Mailing Address - Fax:740-454-1470
Practice Address - Street 1:999 GARDEN RD
Practice Address - Street 2:
Practice Address - City:ZANESVILLE
Practice Address - State:OH
Practice Address - Zip Code:43701-1330
Practice Address - Country:US
Practice Address - Phone:740-454-8193
Practice Address - Fax:740-454-1470
Is Sole Proprietor?:No
Enumeration Date:2005-12-02
Last Update Date:2012-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35 066059174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000119762OtherANTHEM BLUE CROSS BLUE SHIELD
OH0962356Medicaid
OHF39165Medicare UPIN
OH0962356Medicaid
OH100006081Medicare PIN