Provider Demographics
NPI:1699709014
Name:FUTERMAN, CHERYL L (MD)
Entity type:Individual
Prefix:DR
First Name:CHERYL
Middle Name:L
Last Name:FUTERMAN
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 1:400 CHANNING AVE
Mailing Address - Street 2:
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94301-2801
Mailing Address - Country:US
Mailing Address - Phone:650-323-1343
Mailing Address - Fax:650-323-1352
Practice Address - Street 1:400 CHANNING AVE
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94301-2801
Practice Address - Country:US
Practice Address - Phone:650-323-1343
Practice Address - Fax:650-323-1352
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2014-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG617022085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF37880Medicare UPIN
CAZZZ31833ZMedicare ID - Type UnspecifiedPROVIDER NUMBER
CACA113741Medicare PIN