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General NPI Number Information
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NPI Number | 1356491484
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Entity Type | Individual
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Provider Name | A DOUGLAS CHERVENAK D.O.
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Gender | Male
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Dates
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Enumeration Date | 01/11/2007
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Last Update Date | 08/03/2022
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Provider Practice Location Address
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Address Line | 671 S CARTER RD STE 12
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City | SMYRNA
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State | DE
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Zip | 19977-7727
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Country | US
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Telephone | 302-653-1050
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Fax | 302-653-1089
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Provider Business Mailing Address
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Address Line | 319 N CARTERS RD
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City | SMYRNA
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State | DE
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Zip | 19977-1282
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Country | US
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Telephone | 302-653-1050
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Fax | 302-653-1089
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | C2-0003255
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License Number State | DE
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