Healthcare Provider Details

I. General information

NPI: 1629090600
Provider Name (Legal Business Name): CHERIE DARLENE ERTHA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 01/25/2023
Certification Date: 12/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 BOULDER POINT DR
PLYMOUTH NH
03264-3168
US

IV. Provider business mailing address

16 HOSPITAL RD
PLYMOUTH NH
03264-1126
US

V. Phone/Fax

Practice location:
  • Phone: 603-536-1881
  • Fax:
Mailing address:
  • Phone: 603-238-6447
  • Fax: 603-536-2017

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number28155
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number80607
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number80607
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: