Provider Demographics
NPI:1316934961
Name:COX, CHERYL ANN (MD)
Entity type:Individual
Prefix:DR
First Name:CHERYL
Middle Name:ANN
Last Name:COX
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 1:4607 MACCORKLE AVE SW STE 406
Mailing Address - Street 2:
Mailing Address - City:SOUTH CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25309-1364
Mailing Address - Country:US
Mailing Address - Phone:304-766-4342
Mailing Address - Fax:304-766-3541
Practice Address - Street 1:4607 MACCORKLE AVE SW STE 406
Practice Address - Street 2:
Practice Address - City:SOUTH CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25309-1364
Practice Address - Country:US
Practice Address - Phone:304-766-4342
Practice Address - Fax:304-766-3541
Is Sole Proprietor?:No
Enumeration Date:2005-09-29
Last Update Date:2020-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV18445207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810024049OtherTHSPP GROUP MEDICAID
WVB441OtherTHSPP GROUP MEDICARE
WV3810016738Medicaid
WV3810003017OtherKVGA GROUP MEDICAID
WV3810024049OtherTHSPP GROUP MEDICAID