Physician Compare National (NPI:1356491484)

HEALTHCARE PROVIDER: A DOUGLAS CHERVENAK D.O.

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1356491484
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	6103953328
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20120607000567
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	CHERVENAK
	Individual professional last name
Provider First Name	A DOUGLAS
	Individual professional first name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	PHILADELPHIA COLLEGE OF OSTEOPATHIC MEDICINE
	Individual professional's medical school
Graduation Year	1973
	Individual professional's medical school graduation year
Primary Specialty	FAMILY MEDICINE
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	319 N CARTER RD
	Group Practice or individual's line 1 address
City	SMYRNA
	Group Practice or individual's city
State	DE
	Group Practice or individual's state
Zip Code	199771282
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	080004
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	BAYHEALTH HOSPITAL, KENT CAMPUS
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	080001
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	CHRISTIANA HOSPITAL
	Legal business name of hospital where individual professional provides service 2
Hospital Affiliation CCN 3	080009
	Medicare CCN of hospital where individual professional provides service 3
Hospital Affiliation LBN 3	BAYHEALTH - MILFORD MEMORIAL HOSPITAL
	Legal business name of hospital where individual professional provides service 3
Professional Accepts Medicare Assignment	M