Provider Demographics
NPI:1942240395
Name:CHERVENAK, CAROL L (MD)
Entity Type:Individual
Prefix:DR
First Name:CAROL
Middle Name:L
Last Name:CHERVENAK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1054 29TH AVE SW
Mailing Address - Street 2:PO BOX 68
Mailing Address - City:ALBANY
Mailing Address - State:OR
Mailing Address - Zip Code:97321-3416
Mailing Address - Country:US
Mailing Address - Phone:541-926-2203
Mailing Address - Fax:541-926-1378
Practice Address - Street 1:1054 29TH AVE SW
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:OR
Practice Address - Zip Code:97321-3416
Practice Address - Country:US
Practice Address - Phone:541-926-2203
Practice Address - Fax:541-926-1378
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2016-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD16835207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR165515Medicare UPIN