MEDICARE: DR. CHERYL A MANN MD

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
1	207Q00000X	Family Medicine Physician	35069861	OH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	080186052	OTHER	OH	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	010645905	OTHER	OH	TAX ID #
3	000000233110	OTHER	OH	ANTHEM PIN #

General Provider Information

NPI Number	:	1265437354
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHERYL A MANN MD

Provider Business Mailing Address
First Line	:	805 E PIKE ST
Second Line	:
City	:	JACKSON CENTER
State	:	OH
Zip	:	45334-0626
Country	:	US
Telephone Number	:	937-596-0456
Fax Number	:	937-596-0462

Provider Business Practice Location Address
First Line	:	805 E PIKE ST
Second Line	:
City	:	JACKSON CENTER
State	:	OH
Zip	:	45334-0626
Country	:	US
Telephone Number	:	937-596-0456
Fax Number	:	937-596-0462

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	01/04/2017

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Directions to “ DR. CHERYL A MANN MD” Practice Location

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