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
State | License ID | Taxonomies |
---|---|---|
PA | OS003226L | 207RH0003X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207RH0003X | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
PA | 401780 | Other | HIGHMARK BLUE SHIELD |
PA | 50047264 | Other | CAPITAL BLUE CROSS |
50107205 | Other | BLUE CROSS | |
PA | 001165613 | Medicaid | |
PA | 001165613 | Medicaid | |
PA | 50047264 | Other | CAPITAL BLUE CROSS |