Provider Demographics
NPI:1750726550
Name:CHERRY, MARIYAM (MD)
Entity type:Individual
Prefix:DR
First Name:MARIYAM
Middle Name:
Last Name:CHERRY
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 MEDICAL PARK DR STE B
Mailing Address - Street 2:
Mailing Address - City:LUFKIN
Mailing Address - State:TX
Mailing Address - Zip Code:75904-3135
Mailing Address - Country:US
Mailing Address - Phone:936-899-5682
Mailing Address - Fax:936-899-5685
Practice Address - Street 1:107 MEDICAL PARK DR STE B
Practice Address - Street 2:
Practice Address - City:LUFKIN
Practice Address - State:TX
Practice Address - Zip Code:75904-3135
Practice Address - Country:US
Practice Address - Phone:936-899-5682
Practice Address - Fax:936-899-5685
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-07
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ8705207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine