Provider Demographics
NPI:1740231091
Name:CHERIAN, GEORGE R (MD, PC)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:R
Last Name:CHERIAN
Suffix:
Gender:M
Credentials:MD, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:803 W MAHONING ST
Mailing Address - Street 2:
Mailing Address - City:PUNXSUTAWNEY
Mailing Address - State:PA
Mailing Address - Zip Code:15767-1309
Mailing Address - Country:US
Mailing Address - Phone:814-938-0123
Mailing Address - Fax:814-938-2344
Practice Address - Street 1:803 W MAHONING ST
Practice Address - Street 2:
Practice Address - City:PUNXSUTAWNEY
Practice Address - State:PA
Practice Address - Zip Code:15767-1309
Practice Address - Country:US
Practice Address - Phone:814-938-0123
Practice Address - Fax:814-938-2344
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-12
Last Update Date:2014-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD037172L174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1023911OtherGATEWAY
PA0006183300001Medicaid
PA75865OtherUNISON HEALTH CARE
PA010016533OtherPALMETTO GBA - RAILROAD
PA200688OtherUPMC HEALTH PLAN
PA01327036OtherPA BLUE SHIELD
PA01327036OtherPA BLUE SHIELD
PA0006183300001Medicaid