Provider Demographics
NPI:1508872961
Name:LORI L CHERUP MD LLC
Entity Type:Organization
Organization Name:LORI L CHERUP MD LLC
Other - Org Name:LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MAUREEN
Authorized Official - Middle Name:
Authorized Official - Last Name:STANKEVICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-220-8181
Mailing Address - Street 1:701 BOYCE ROAD
Mailing Address - Street 2:
Mailing Address - City:BRIDGEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15017
Mailing Address - Country:US
Mailing Address - Phone:412-220-8181
Mailing Address - Fax:412-220-1150
Practice Address - Street 1:701 BOYCE ROAD
Practice Address - Street 2:
Practice Address - City:BRIDGEVILLE
Practice Address - State:PA
Practice Address - Zip Code:15017
Practice Address - Country:US
Practice Address - Phone:412-220-8181
Practice Address - Fax:412-220-1150
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-31
Last Update Date:2008-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD14649208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2266OtherHEALTH AMERICA
PA555329OtherBLUE SHIELD
PA1002296Medicaid
PA2266OtherHEALTH AMERICA
E52836Medicare UPIN