MEDICARE: CHERYL A HERMAN PA-C

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	363A00000X	Physician Assistant	OA000128L	PA

General Provider Information

NPI Number	:	1639284250
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHERYL A HERMAN PA-C

Provider Business Mailing Address
First Line	:	21 7TH ST
Second Line	:
City	:	MIDLAND
State	:	PA
Zip	:	15059-1452
Country	:	US
Telephone Number	:	724-643-4852
Fax Number	:	724-770-7940

Provider Business Practice Location Address
First Line	:	21 7TH ST
Second Line	:
City	:	MIDLAND
State	:	PA
Zip	:	15059-1452
Country	:	US
Telephone Number	:	724-643-4852
Fax Number	:	724-643-6549

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

Provider Enumeration Date	:	08/21/2006
Last Update Date	:	01/18/2010

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