Provider Demographics
NPI:1699850370
Name:COLBERT, CHERYL CORINNE (MD)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:CORINNE
Last Name:COLBERT
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 1:52 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12401-3828
Mailing Address - Country:US
Mailing Address - Phone:845-338-1700
Mailing Address - Fax:845-338-9831
Practice Address - Street 1:52 MAIN ST
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-3828
Practice Address - Country:US
Practice Address - Phone:845-338-1700
Practice Address - Fax:845-338-9831
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY198464207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
696261OtherMVP
MC 12N201Medicare ID - Type Unspecified
NYG29526Medicare UPIN