Healthcare Provider Details

I. General information

NPI: 1386758050
Provider Name (Legal Business Name): CHERYL PEGUS MD, MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

1121 BETHLEHEM PIKE #60-284
SPRING HOUSE PA
19477-1102
US

IV. Provider business mailing address

1121 BETHLEHEM PIKE #60-284
SPRING HOUSE PA
19477-1102
US

V. Phone/Fax

Practice location:
  • Phone: 215-565-6075
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number184455
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: