Provider Demographics
NPI:1629090600
Name:ERTHA, CHERIE DARLENE (MD)
Entity Type:Individual
Prefix:
First Name:CHERIE
Middle Name:DARLENE
Last Name:ERTHA
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 1:16 HOSPITAL RD
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03264-1126
Mailing Address - Country:US
Mailing Address - Phone:603-238-6447
Mailing Address - Fax:603-536-2017
Practice Address - Street 1:103 BOULDER POINT DR
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03264-3168
Practice Address - Country:US
Practice Address - Phone:603-536-1881
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV28155207P00000X
MA80607207PE0004X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3142418Medicaid
MA080607OtherTUFTS HEALTH PLAN
MAJ31270OtherBLUE CROSS & BLUE SHIELD
MAA20156Medicare ID - Type Unspecified
MAF71795Medicare UPIN