Provider Demographics
NPI:1194711549
Name:WEINER, CHERYL LYNN (DPM)
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:LYNN
Last Name:WEINER
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1045 BEECHER XING N
Mailing Address - Street 2:STE A
Mailing Address - City:GAHANNA
Mailing Address - State:OH
Mailing Address - Zip Code:43230-4573
Mailing Address - Country:US
Mailing Address - Phone:614-478-2111
Mailing Address - Fax:614-304-0022
Practice Address - Street 1:1045 BEECHER XING N
Practice Address - Street 2:SUITE A
Practice Address - City:GAHANNA
Practice Address - State:OH
Practice Address - Zip Code:43230-4573
Practice Address - Country:US
Practice Address - Phone:614-478-2111
Practice Address - Fax:614-304-0022
Is Sole Proprietor?:No
Enumeration Date:2005-09-21
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36002329213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0625649Medicaid
OH10801172OtherCAQH
OH10801172OtherCAQH
OH0625649Medicaid
OH0583163Medicare ID - Type Unspecified