Provider Demographics
NPI:1003882762
Name:CHERIYAN, ANITA (MD)
Entity type:Individual
Prefix:
First Name:ANITA
Middle Name:
Last Name:CHERIYAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20525 CENTER RIDGE RD
Mailing Address - Street 2:STE 220
Mailing Address - City:ROCKY RIVER
Mailing Address - State:OH
Mailing Address - Zip Code:44116
Mailing Address - Country:US
Mailing Address - Phone:440-895-5056
Mailing Address - Fax:440-895-5050
Practice Address - Street 1:25200 CENTER RIDGE RD
Practice Address - Street 2:#3200
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145
Practice Address - Country:US
Practice Address - Phone:440-895-5040
Practice Address - Fax:440-895-5073
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35052512C207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
2822259OtherAETNA
000000221925OtherANTHEM
0406871OtherUNITED HEALTHCARE
OH0660995Medicaid
M52512OtherSUMMACARE APEX
341783789067OtherCARESOURCE
2822259OtherAETNA
A16896Medicare UPIN