Provider Demographics
NPI:1497939235
Name:GEORGE R. CHERIAN, M.D., P.C.
Entity Type:Organization
Organization Name:GEORGE R. CHERIAN, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:R
Authorized Official - Last Name:CHERIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD , PC
Authorized Official - Phone:814-938-0123
Mailing Address - Street 1:803 W MAHONING ST
Mailing Address - Street 2:
Mailing Address - City:PUNXSUTAWNEY
Mailing Address - State:PA
Mailing Address - Zip Code:15767-1309
Mailing Address - Country:US
Mailing Address - Phone:814-938-0123
Mailing Address - Fax:814-938-2344
Practice Address - Street 1:803 W MAHONING ST
Practice Address - Street 2:
Practice Address - City:PUNXSUTAWNEY
Practice Address - State:PA
Practice Address - Zip Code:15767-1309
Practice Address - Country:US
Practice Address - Phone:814-938-0123
Practice Address - Fax:814-938-2344
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-27
Last Update Date:2014-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD07172L174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1327036OtherPENNSYLVANIA BLUE SHIELD
PA0006183300001Medicaid
PA069746Medicare PIN
PA1327036OtherPENNSYLVANIA BLUE SHIELD