Provider Demographics
NPI:1922046523
Name:CHERTOW, TODD ERIC (MD)
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:ERIC
Last Name:CHERTOW
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 1:7500 CENTRAL AVE
Mailing Address - Street 2:SUITE 108
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19111-2430
Mailing Address - Country:US
Mailing Address - Phone:215-745-4050
Mailing Address - Fax:215-745-9333
Practice Address - Street 1:7500 CENTRAL AVE
Practice Address - Street 2:SUITE 108
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19111-2430
Practice Address - Country:US
Practice Address - Phone:215-745-4050
Practice Address - Fax:215-745-9333
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2014-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD433323207X00000X
NY245610207XX0005X
PAMD43323207XX0005X, 207X00000X
NJ25MA07510400207X00000X
WV23503207X00000X
GA57292207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1020838470002Medicaid
PA1020838470002Medicaid