Provider Demographics
NPI:1598764383
Name:ALBANESE, CHERYL LEE (MD)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:LEE
Last Name:ALBANESE
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 1:3406 PEACH ST
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16508-2740
Mailing Address - Country:US
Mailing Address - Phone:814-877-5381
Mailing Address - Fax:814-864-3471
Practice Address - Street 1:3406 PEACH ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16508-2740
Practice Address - Country:US
Practice Address - Phone:814-877-5381
Practice Address - Fax:814-864-3471
Is Sole Proprietor?:No
Enumeration Date:2005-07-14
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD021971E207Q00000X
PAMD-021971-E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0012702070001Medicaid
PA407271OtherBLUE SHIELD
NY01413836OtherNY MEDICAID
PA519462OtherAETNA
PA0012702070001Medicaid
PA080194884OtherRR MEDICARE
NY00026326401OtherUNIVERA
OH0915648OtherOH MEDICAL ASSISTANCE
PA159388OtherUNISON
OH0915648OtherOH MEDICAL ASSISTANCE
B41301Medicare UPIN