Provider Demographics
NPI:1770583494
Name:CHERNOSKY, DEBRA LYNN (MD)
Entity type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:LYNN
Last Name:CHERNOSKY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4646 WILD INDIGO ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77027-7008
Mailing Address - Country:US
Mailing Address - Phone:713-790-9270
Mailing Address - Fax:713-790-1260
Practice Address - Street 1:4646 WILD INDIGO ST
Practice Address - Street 2:SUITE 100
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77027-7008
Practice Address - Country:US
Practice Address - Phone:713-790-9270
Practice Address - Fax:713-790-1260
Is Sole Proprietor?:No
Enumeration Date:2005-07-22
Last Update Date:2016-08-24
Deactivation Date:2006-03-21
Deactivation Code:
Reactivation Date:2006-03-27
Provider Licenses
StateLicense IDTaxonomies
TXH0248207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXF07827Medicare UPIN
TX83M642Medicare PIN