Provider Demographics
NPI:1972793792
Name:CHERYL A. DUFFY, MD, INC.
Entity type:Organization
Organization Name:CHERYL A. DUFFY, MD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:
Authorized Official - Last Name:DUFFY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:724-981-1219
Mailing Address - Street 1:2425 GARDEN WAY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:HERMITAGE
Mailing Address - State:PA
Mailing Address - Zip Code:16148-5215
Mailing Address - Country:US
Mailing Address - Phone:724-981-1219
Mailing Address - Fax:724-981-9288
Practice Address - Street 1:2425 GARDEN WAY
Practice Address - Street 2:SUITE 101
Practice Address - City:HERMITAGE
Practice Address - State:PA
Practice Address - Zip Code:16148-5215
Practice Address - Country:US
Practice Address - Phone:724-981-1219
Practice Address - Fax:724-981-9288
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-27
Last Update Date:2007-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PWMD049897L291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA14237900008Medicaid