Provider Demographics
NPI:1659310787
Name:CHERNICK, RICHARD JAY (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:JAY
Last Name:CHERNICK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:RICHARD
Other - Middle Name:J
Other - Last Name:CHERNICK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:6701 AIRPORT BLVD
Mailing Address - Street 2:SUITE D-330
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36608-6705
Mailing Address - Country:US
Mailing Address - Phone:251-607-9797
Mailing Address - Fax:251-607-9761
Practice Address - Street 1:6701 AIRPORT BLVD
Practice Address - Street 2:SUITE D-330
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608-6705
Practice Address - Country:US
Practice Address - Phone:251-607-9797
Practice Address - Fax:251-607-9761
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00020774207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL510-30076OtherBLUE CROSS BLUE SHIELD
MS0118074Medicaid
AL510-30076OtherBLUE CROSS BLUE SHIELD