Healthcare Provider Details

I. General information

NPI: 1699325233
Provider Name (Legal Business Name): CHERYL R BELLAIRE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2019
Last Update Date: 09/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

296 MAIN ST
EXTON PA
19341-3700
US

IV. Provider business mailing address

296 MAIN ST
EXTON PA
19341-3700
US

V. Phone/Fax

Practice location:
  • Phone: 610-363-9206
  • Fax: 610-363-9209
Mailing address:
  • Phone: 610-363-9206
  • Fax: 610-363-9209

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VII. Legacy identifiers

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

# 1
Identifier0016931970005
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name: MARGUERITE L PANTANO
Title or Position: OFFICE MANAGER
Credential:
Phone: 610-363-9206