Provider Demographics
NPI:1619962115
Name:CHERNE, MELVIN (MD)
Entity Type:Individual
Prefix:
First Name:MELVIN
Middle Name:
Last Name:CHERNE
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 15648
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95852-0648
Mailing Address - Country:US
Mailing Address - Phone:951-781-2270
Mailing Address - Fax:951-781-2293
Practice Address - Street 1:85 SIERRA PARK RD
Practice Address - Street 2:
Practice Address - City:MAMMOTH LAKES
Practice Address - State:CA
Practice Address - Zip Code:93546-2073
Practice Address - Country:US
Practice Address - Phone:760-924-4070
Practice Address - Fax:760-924-4207
Is Sole Proprietor?:No
Enumeration Date:2005-09-12
Last Update Date:2020-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG535552085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA360002056Medicaid
CA00G535550Medicaid
CA00G535555Medicare PIN
CA00G535550Medicare PIN
E25290Medicare UPIN
CA00G535550Medicaid
CA00G535556Medicare PIN
CA00G535554Medicare PIN
CA300015275Medicare PIN
CA00G535553Medicare PIN
CA00G535552Medicare PIN
CA00G535551Medicare PIN