Provider Demographics
NPI:1194731083
Name:DAVIS, CHERYL L (MD)
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:L
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:201 MERION AVE
Mailing Address - Street 2:
Mailing Address - City:HADDONFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:08033-1412
Mailing Address - Country:US
Mailing Address - Phone:856-216-7446
Mailing Address - Fax:856-216-0126
Practice Address - Street 1:5501 OLD YORK RD
Practice Address - Street 2:PALEY 1321
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19141-3018
Practice Address - Country:US
Practice Address - Phone:215-456-8324
Practice Address - Fax:215-456-3436
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2013-10-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA070872002080N0001X
PAMD073159L2080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8745901Medicaid
PA0018822470008Medicaid