Healthcare Provider Details

I. General information

NPI: 1821017195
Provider Name (Legal Business Name): CHERYL ANN KERNS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 ATLANTIC AVE
MARBLEHEAD MA
01945-3042
US

IV. Provider business mailing address

69 POND ST
MARBLEHEAD MA
01945-2604
US

V. Phone/Fax

Practice location:
  • Phone: 781-631-7800
  • Fax: 781-631-4319
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number41361
License Number StateMA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: