Provider Demographics
NPI:1629041504
Name:MAR-CHAN, CHERRY (MD)
Entity Type:Individual
Prefix:DR
First Name:CHERRY
Middle Name:
Last Name:MAR-CHAN
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 1:41 BRUNSWICK ST FL 1
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-6017
Mailing Address - Country:US
Mailing Address - Phone:718-983-0660
Mailing Address - Fax:718-983-7523
Practice Address - Street 1:41 BRUNSWICK ST FL 1
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-6017
Practice Address - Country:US
Practice Address - Phone:718-983-0660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2019-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY221394207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0102544OtherUHC MEDICAID/MEDICARE
NY02208437Medicaid
NY203485113OtherNYS TAX ID
NY150258OtherCONSUMER HEALTH NETWORK
NYP2552417OtherOXFORD
NY7927339OtherAETNA PPO
NY2155690OtherUNITED HEALTH CARE
NY2793255OtherAETNA HMO/QPOS
NY102400OtherGHI HMO
NY02208437Medicaid
NY2793255OtherAETNA HMO/QPOS