Provider Demographics
NPI:1396710380
Name:CHEESBOROUGH, JOHN DAVIDSON (MD)
Entity type:Individual
Prefix:
First Name:JOHN DAVIDSON
Middle Name:
Last Name:CHEESBOROUGH
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 1:1911 K M WICKER MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27330-5070
Mailing Address - Country:US
Mailing Address - Phone:919-775-7926
Mailing Address - Fax:919-718-0092
Practice Address - Street 1:1911 K M WICKER MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:NC
Practice Address - Zip Code:27330-5070
Practice Address - Country:US
Practice Address - Phone:919-775-7926
Practice Address - Fax:919-718-0092
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2022-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC21635207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC21635OtherNORTH CAROLINA MEDICAL BOARD