Provider Demographics
NPI:1124137906
Name:MARY LEE CHERRY, MD APMC
Entity type:Organization
Organization Name:MARY LEE CHERRY, MD APMC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:CHERRY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:985-809-3883
Mailing Address - Street 1:204 HIGHLAND PARK PLZ
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-7129
Mailing Address - Country:US
Mailing Address - Phone:985-809-3883
Mailing Address - Fax:985-809-3886
Practice Address - Street 1:204 HIGHLAND PARK PLZ
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-7129
Practice Address - Country:US
Practice Address - Phone:985-809-3883
Practice Address - Fax:985-809-3886
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2008-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA020710207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5CT95Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER