Provider Demographics
NPI:1770569147
Name:CHERRY TREE PHYSICIAN ASSOCIATES PC
Entity type:Organization
Organization Name:CHERRY TREE PHYSICIAN ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:
Authorized Official - Last Name:KLEYHAUER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-741-8100
Mailing Address - Street 1:1020A E BOAL AVE
Mailing Address - Street 2:
Mailing Address - City:BOALSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:16827-1509
Mailing Address - Country:US
Mailing Address - Phone:814-237-8627
Mailing Address - Fax:814-238-0083
Practice Address - Street 1:773 CHERRY TREE CT
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:PA
Practice Address - Zip Code:17331-7902
Practice Address - Country:US
Practice Address - Phone:717-741-8100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA2085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA122452OtherTHREE RIVERS HEALTH PLAN
PA1525714OtherGATEWAY
PA0017303250002Medicaid
PA2586800OtherCAPITAL BC
PA263000OtherMAMSI
PA383789OtherBCBS HIGHMARK
PA993971OtherKEYSTONE HPC
PA0017303250002Medicaid
PA=========OtherHEALTH AMERICA
PA383789OtherBCBS HIGHMARK