MEDICARE: DR. MARTIN D CHEATLE PHD

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	103TB0200X	Cognitive & Behavioral Psychologist	PS003654L	PA

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

General Provider Information

NPI Number	:	1548262629
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARTIN D CHEATLE PHD

Provider Business Mailing Address
First Line	:	50 COMMERCE DR
Second Line	:
City	:	WYOMISSING
State	:	PA
Zip	:	19610-3335
Country	:	US
Telephone Number	:	610-372-8044
Fax Number	:

Provider Business Practice Location Address
First Line	:	560 VAN REED RD
Second Line	:	SUITE 204
City	:	WYOMISSING
State	:	PA
Zip	:	19610-1799
Country	:	US
Telephone Number	:	610-988-4951
Fax Number	:

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

Provider Enumeration Date	:	06/02/2005
Last Update Date	:	09/01/2015

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