Provider Demographics
NPI:1891719274
Name:CHERTOK, HAROLD A (DO)
Entity Type:Individual
Prefix:
First Name:HAROLD
Middle Name:A
Last Name:CHERTOK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:445 N CEDAR AVE
Mailing Address - Street 2:
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38501-2422
Mailing Address - Country:US
Mailing Address - Phone:931-528-5787
Mailing Address - Fax:931-528-5796
Practice Address - Street 1:445 N CEDAR AVE
Practice Address - Street 2:
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-2422
Practice Address - Country:US
Practice Address - Phone:931-528-5787
Practice Address - Fax:931-528-5796
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2011-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDO1351207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H27757Medicare UPIN
TN3306371Medicare PIN
TN3720842Medicare PIN