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NPI Code Detail

MEDICARE: CHERYL D PITTSFORD PA-C

MEDICARE: CHERYL D PITTSFORD PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant10000443AIN

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1090540091OTHERINMEDICARE PTAN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1205834546
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHERYL D PITTSFORD PA-C
Provider Business Mailing Address
First Line : PO BOX 1329
Second Line :
City : BLOOMINGTON
State : IN
Zip : 47402-1329
Country : US
Telephone Number : 812-353-3087
Fax Number :
Provider Business Practice Location Address
First Line : 2920 S MCINTIRE DR
Second Line : SUITE 350
City : BLOOMINGTON
State : IN
Zip : 47403-4221
Country : US
Telephone Number : 812-353-3277
Fax Number : 812-339-2934
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/11/2005
Last Update Date : 09/26/2023

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Directions to “ CHERYL D PITTSFORD PA-C” Practice Location

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