Provider Demographics
NPI:1457388241
Name:CONETSCO, CHERYL A (DO)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:A
Last Name:CONETSCO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2326 18TH ST
Mailing Address - Street 2:STE 210
Mailing Address - City:COLUMBUS
Mailing Address - State:IN
Mailing Address - Zip Code:47201
Mailing Address - Country:US
Mailing Address - Phone:812-372-8426
Mailing Address - Fax:812-372-8301
Practice Address - Street 1:2326 18TH ST
Practice Address - Street 2:STE 210
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47201
Practice Address - Country:US
Practice Address - Phone:812-372-8426
Practice Address - Fax:812-372-8301
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2012-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02002736A207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1790837789OtherGROUP NPI
IN200482230Medicaid
P00249217OtherMEDICARE RAILROAD
000000329870OtherANTHEM
40647OtherSIHO
P00249217OtherMEDICARE RAILROAD
IN1790837789OtherGROUP NPI