Provider Demographics
NPI:1649365487
Name:CHERRY B. LOBATON MD, INC
Entity type:Organization
Organization Name:CHERRY B. LOBATON MD, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHERRY
Authorized Official - Middle Name:B
Authorized Official - Last Name:LOBATON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-262-2538
Mailing Address - Street 1:1004 SUSHRUTA DR STE D
Mailing Address - Street 2:
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25401-8898
Mailing Address - Country:US
Mailing Address - Phone:304-262-2538
Mailing Address - Fax:304-262-2583
Practice Address - Street 1:1004 SUSHRUTA DR STE D
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25401-8898
Practice Address - Country:US
Practice Address - Phone:304-262-2538
Practice Address - Fax:304-262-2583
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2010-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810005921Medicaid
WV5630394000Medicaid
WV4017942Medicare PIN
WV5630394000Medicaid