Provider Demographics
NPI:1538325493
Name:CHERUP, LORI L (MD)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:L
Last Name:CHERUP
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 BOYCE RD
Mailing Address - Street 2:
Mailing Address - City:BRIDGEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15017-1225
Mailing Address - Country:US
Mailing Address - Phone:412-220-8181
Mailing Address - Fax:412-220-1150
Practice Address - Street 1:701 BOYCE RD
Practice Address - Street 2:
Practice Address - City:BRIDGEVILLE
Practice Address - State:PA
Practice Address - Zip Code:15017-1225
Practice Address - Country:US
Practice Address - Phone:412-220-8181
Practice Address - Fax:412-220-1150
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-31
Last Update Date:2015-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD030907E174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA469236OtherBLUE SHIELD
PAE52836Medicare UPIN
PA469236Medicare PIN