Provider Demographics
NPI:1952387300
Name:ALENCHERRY, JOHNY (MD)
Entity Type:Individual
Prefix:
First Name:JOHNY
Middle Name:
Last Name:ALENCHERRY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12821 OAK HILL AVE
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21742-2940
Mailing Address - Country:US
Mailing Address - Phone:301-733-0300
Mailing Address - Fax:301-733-5773
Practice Address - Street 1:12821 OAK HILL AVE
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21742-2940
Practice Address - Country:US
Practice Address - Phone:301-733-0300
Practice Address - Fax:301-733-5773
Is Sole Proprietor?:No
Enumeration Date:2005-12-19
Last Update Date:2022-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMO-039584-E207RP1001X
WV19105207RP1001X
MDD41786207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD777091000Medicaid
094L762AMedicare ID - Type Unspecified
F18649Medicare UPIN