MEDICARE: PATRICIA CHERRY LDN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133VN1006X	Metabolic Nutrition Registered Dietitian	L000742	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5040770	OTHER	NC	UNITED HEALTHCARE
2	312280	OTHER	NC	FEDERAL BLACK LUNG
3	00207	OTHER	NC	BLUE CROSS
4	0067840	OTHER	NC	AETNA
5	0590625010	OTHER	NC	CIGNA
6	3697	OTHER	NC	WELLPATH
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1417931882
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICIA CHERRY LDN

Provider Business Mailing Address
First Line	:	1316 MIDWOOD DR
Second Line	:
City	:	GASTONIA
State	:	NC
Zip	:	28052-5255
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	660 SUMMIT CROSSING PL
Second Line	:	SUITE #306
City	:	GASTONIA
State	:	NC
Zip	:	28054-2104
Country	:	US
Telephone Number	:	704-671-7830
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/30/2005
Last Update Date	:	08/29/2007

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Directions to “ PATRICIA CHERRY LDN” Practice Location

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