Provider Demographics
NPI:1528202413
Name:MCHERRON, TONY ISIAH (MD)
Entity Type:Individual
Prefix:
First Name:TONY
Middle Name:ISIAH
Last Name:MCHERRON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:6626 E 75TH ST
Mailing Address - Street 2:SUITE 500
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-2890
Mailing Address - Country:US
Mailing Address - Phone:765-298-4449
Mailing Address - Fax:765-298-4992
Practice Address - Street 1:1629 MEDICAL ARTS BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:ANDERSON
Practice Address - State:IN
Practice Address - Zip Code:46011-3454
Practice Address - Country:US
Practice Address - Phone:765-298-5439
Practice Address - Fax:765-298-4920
Is Sole Proprietor?:No
Enumeration Date:2009-04-23
Last Update Date:2023-11-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN01071812A208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201112110Medicaid
IN266180067Medicare PIN