Provider Demographics
NPI:1891768610
Name:CHERRY, THOMAS ISIDOR (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:ISIDOR
Last Name:CHERRY
Suffix:
Gender:M
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:PO BOX 50095
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98145-5095
Mailing Address - Country:US
Mailing Address - Phone:206-543-6420
Mailing Address - Fax:
Practice Address - Street 1:4915 25TH AVE NE STE 300W
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-5668
Practice Address - Country:US
Practice Address - Phone:206-525-7777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-10
Last Update Date:2016-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAWA60382430207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1891768610Medicaid
WA8937126Medicare PIN
TX7271097OtherAETNA
TX81803GOtherBCBS OF TEXAS
TX752616977041OtherTRICARE CHAMPUS
G78107Medicare UPIN
TX080153540Medicare PIN
TX8L19994Medicare Oscar/Certification
TX123457OtherCHIPS
TX102628803Medicaid