MEDICARE: DR. ALLAN JOEL CHERNOV M.D.

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	207R00000X	Internal Medicine Physician	L3263	TX

General Provider Information

NPI Number	:	1720265259
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALLAN JOEL CHERNOV M.D.

Provider Business Mailing Address
First Line	:	901 S CENTRAL EXPY
Second Line	:	NORTH BUILDING, MAIL STOP E
City	:	RICHARDSON
State	:	TX
Zip	:	75080-7302
Country	:	US
Telephone Number	:	972-766-1149
Fax Number	:	972-766-5559

Provider Business Practice Location Address
First Line	:	901 S CENTRAL EXPY
Second Line	:	NORTH BUILDING, MAIL STOP E
City	:	RICHARDSON
State	:	TX
Zip	:	75080-7302
Country	:	US
Telephone Number	:	972-766-1149
Fax Number	:	972-766-5559

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

Provider Enumeration Date	:	01/28/2008
Last Update Date	:	01/28/2008

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