Provider Demographics
NPI:1285622043
Name:CHERRY, REBECCA T (MD)
Entity type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:T
Last Name:CHERRY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2633 COMMONS BLVD STE 120
Mailing Address - Street 2:
Mailing Address - City:BEAVERCREEK
Mailing Address - State:OH
Mailing Address - Zip Code:45431-3827
Mailing Address - Country:US
Mailing Address - Phone:937-427-7540
Mailing Address - Fax:937-427-7810
Practice Address - Street 1:2633 COMMONS BLVD STE 120
Practice Address - Street 2:
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45431-3827
Practice Address - Country:US
Practice Address - Phone:937-427-7540
Practice Address - Fax:937-427-7810
Is Sole Proprietor?:No
Enumeration Date:2005-10-06
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35062231C207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0924745Medicaid
OHCH4215561Medicare PIN
OH0924745Medicaid