Provider Demographics
NPI:1801970512
Name:CHEREN, ISA (MD)
Entity type:Individual
Prefix:
First Name:ISA
Middle Name:
Last Name:CHEREN
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 1:319 N GRAHAM HOPEDALE RD
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27217-2990
Mailing Address - Country:US
Mailing Address - Phone:336-227-0101
Mailing Address - Fax:
Practice Address - Street 1:319 N GRAHAM HOPEDALE RD
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27217-2990
Practice Address - Country:US
Practice Address - Phone:336-227-0101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2012-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC34275207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2166890GMedicare ID - Type Unspecified
F15198Medicare ID - Type Unspecified
NC7922249Medicare ID - Type Unspecified