Provider Demographics
NPI:1396970950
Name:CHERIAN, CECIL A (MD)
Entity type:Individual
Prefix:
First Name:CECIL
Middle Name:A
Last Name:CHERIAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:10051 5TH STREET NORTH ATTN: CREDENTIALING
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33702
Mailing Address - Country:US
Mailing Address - Phone:727-824-0780
Mailing Address - Fax:813-634-8210
Practice Address - Street 1:781 CYPRESS VILLAGE BLVD
Practice Address - Street 2:
Practice Address - City:RUSKIN
Practice Address - State:FL
Practice Address - Zip Code:33573-6801
Practice Address - Country:US
Practice Address - Phone:813-633-3600
Practice Address - Fax:813-634-8210
Is Sole Proprietor?:No
Enumeration Date:2009-05-26
Last Update Date:2016-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK27027207Q00000X
FLME113498207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL006501200Medicaid
FL006501200Medicaid