Provider Demographics
NPI:1558581082
Name:CHERRY, REBECCA NAOMI (MD)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:NAOMI
Last Name:CHERRY
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 1:419 CHAPEL RD
Mailing Address - Street 2:
Mailing Address - City:ELKINS PARK
Mailing Address - State:PA
Mailing Address - Zip Code:19027-2504
Mailing Address - Country:US
Mailing Address - Phone:858-204-9614
Mailing Address - Fax:
Practice Address - Street 1:7848 OLD YORK RD STE 200A
Practice Address - Street 2:
Practice Address - City:ELKINS PARK
Practice Address - State:PA
Practice Address - Zip Code:19027-2541
Practice Address - Country:US
Practice Address - Phone:215-422-3130
Practice Address - Fax:215-422-3148
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA92747208000000X, 2080P0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric Gastroenterology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1558581082Medicaid