Provider Demographics
NPI:1558394460
Name:CHERNICOFF, DAVID P (DO)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:P
Last Name:CHERNICOFF
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2442 E BAYBERRY DR
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17112-6013
Mailing Address - Country:US
Mailing Address - Phone:717-541-8456
Mailing Address - Fax:
Practice Address - Street 1:2442 E BAYBERRY DR
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17112-6013
Practice Address - Country:US
Practice Address - Phone:717-541-8456
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2019-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS003226L207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA401780OtherHIGHMARK BLUE SHIELD
PA50047264OtherCAPITAL BLUE CROSS
50107205OtherBLUE CROSS
PA001165613Medicaid
PA001165613Medicaid
PA50047264OtherCAPITAL BLUE CROSS