Provider Demographics
NPI:1578504254
Name:GENG, CHERYL (PA)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:
Last Name:GENG
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:CHERYL
Other - Middle Name:
Other - Last Name:COOPER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5345 HENDRON RD
Mailing Address - Street 2:
Mailing Address - City:GROVEPORT
Mailing Address - State:OH
Mailing Address - Zip Code:43125-1055
Mailing Address - Country:US
Mailing Address - Phone:614-835-0070
Mailing Address - Fax:614-835-0301
Practice Address - Street 1:5345 HENDRON RD
Practice Address - Street 2:
Practice Address - City:GROVEPORT
Practice Address - State:OH
Practice Address - Zip Code:43125-1055
Practice Address - Country:US
Practice Address - Phone:614-835-0070
Practice Address - Fax:614-835-0301
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2015-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50-00-1874363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
0024463Medicare PIN