Provider Demographics
NPI:1437209111
Name:CHERRICK, LEO CHARLES (M D)
Entity Type:Individual
Prefix:DR
First Name:LEO
Middle Name:CHARLES
Last Name:CHERRICK
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:764 PINE VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:ARNOLD
Mailing Address - State:MD
Mailing Address - Zip Code:21012-3107
Mailing Address - Country:US
Mailing Address - Phone:301-537-8700
Mailing Address - Fax:410-757-6937
Practice Address - Street 1:1114 DIDONATO DR
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:MD
Practice Address - Zip Code:21619-2663
Practice Address - Country:US
Practice Address - Phone:410-643-4357
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD27363207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine