Healthcare Provider Details

I. General information

NPI: 1205834546
Provider Name (Legal Business Name): CHERYL D PITTSFORD PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHERYL D RAMBO

II. Dates (important events)

Enumeration Date: 07/11/2005
Last Update Date: 09/26/2023
Certification Date: 09/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2920 S MCINTIRE DR SUITE 350
BLOOMINGTON IN
47403-4221
US

IV. Provider business mailing address

PO BOX 1329
BLOOMINGTON IN
47402-1329
US

V. Phone/Fax

Practice location:
  • Phone: 812-353-3277
  • Fax: 812-339-2934
Mailing address:
  • Phone: 812-353-3087
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number10000443A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: