Provider Demographics
NPI:1740301555
Name:CHERNO, MATTHEW B (MD)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:B
Last Name:CHERNO
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 1:1001 SNEATH LN STE 100
Mailing Address - Street 2:
Mailing Address - City:SAN BRUNO
Mailing Address - State:CA
Mailing Address - Zip Code:94066-2349
Mailing Address - Country:US
Mailing Address - Phone:650-866-7111
Mailing Address - Fax:650-866-7183
Practice Address - Street 1:1001 SNEATH LN STE 100
Practice Address - Street 2:
Practice Address - City:SAN BRUNO
Practice Address - State:CA
Practice Address - Zip Code:94066-2349
Practice Address - Country:US
Practice Address - Phone:650-866-7111
Practice Address - Fax:650-866-7183
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2019-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01062468A2085R0202X
TXN06972085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2026973-04Medicaid
TX2026973-04Medicaid