Provider Demographics
NPI:1497723571
Name:MAZEFFA, CHERIE M (DO)
Entity Type:Individual
Prefix:
First Name:CHERIE
Middle Name:M
Last Name:MAZEFFA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:CHERIE
Other - Middle Name:MARIE
Other - Last Name:MININGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:PO BOX 828065
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19182-8065
Mailing Address - Country:US
Mailing Address - Phone:800-666-2455
Mailing Address - Fax:610-617-6280
Practice Address - Street 1:100 E LEHIGH AVENUE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19125
Practice Address - Country:US
Practice Address - Phone:215-707-1656
Practice Address - Fax:215-707-0805
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2019-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS010342L207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0017994900007Medicaid
PA529796OtherHIGHMARK BS
PA0284067000OtherINDEPENDENCE BC
PA529796OtherHIGHMARK BS
PA0017994900007Medicaid