Provider Demographics
NPI:1912063181
Name:FLYNN, CHERYL (MD, PHD)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:
Last Name:FLYNN
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 WAKE ROBIN RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:LINCOLN
Mailing Address - State:RI
Mailing Address - Zip Code:02865-4241
Mailing Address - Country:US
Mailing Address - Phone:401-333-1656
Mailing Address - Fax:401-333-3104
Practice Address - Street 1:2 WAKE ROBIN RD
Practice Address - Street 2:SUITE 202
Practice Address - City:LINCOLN
Practice Address - State:RI
Practice Address - Zip Code:02865-4241
Practice Address - Country:US
Practice Address - Phone:401-333-1656
Practice Address - Fax:401-333-3104
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD08251208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIE73467Medicare UPIN