Provider Demographics
NPI:1588653877
Name:CHERASCU, BOGDAN NICOLAE (MD)
Entity Type:Individual
Prefix:
First Name:BOGDAN
Middle Name:NICOLAE
Last Name:CHERASCU
Suffix:
Gender:M
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:PO BOX 3178
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52406-3178
Mailing Address - Country:US
Mailing Address - Phone:319-398-1583
Mailing Address - Fax:319-399-2085
Practice Address - Street 1:202 10TH STREET SE
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52403-2404
Practice Address - Country:US
Practice Address - Phone:319-398-1546
Practice Address - Fax:319-399-2016
Is Sole Proprietor?:No
Enumeration Date:2005-10-19
Last Update Date:2020-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME016094207R00000X
IA33460207R00000X, 207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AA26120OtherHARVARDPILGRIM
047237OtherANTHEM
ME296550099Medicaid
AA26120OtherHARVARDPILGRIM
H85771Medicare UPIN
MM9959Medicare ID - Type Unspecified