Provider Demographics
NPI:1780607911
Name:CHESHIRE, JOHN A (PA)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:A
Last Name:CHESHIRE
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:808 SCHENCK ST
Mailing Address - Street 2:
Mailing Address - City:SHELBY
Mailing Address - State:NC
Mailing Address - Zip Code:28150-3934
Mailing Address - Country:US
Mailing Address - Phone:704-480-9344
Mailing Address - Fax:704-484-3260
Practice Address - Street 1:812 W KING ST
Practice Address - Street 2:
Practice Address - City:KINGS MOUNTAIN
Practice Address - State:NC
Practice Address - Zip Code:28086-2748
Practice Address - Country:US
Practice Address - Phone:704-480-9344
Practice Address - Fax:704-739-5271
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2016-01-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC103728363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8101161Medicaid
P86376Medicare UPIN
NCNC2959BMedicare PIN
NCNC2959AMedicare PIN