Basic Information
| Provider Information | |||||||||
| NPI: | 1346532264 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHEATHAM | ||||||||
| FirstName: | MORGAN | ||||||||
| MiddleName: | MCCROCKLIN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10150 STAPLES MILL RD C | ||||||||
| Address2: | |||||||||
| City: | GLEN ALLEN | ||||||||
| State: | VA | ||||||||
| PostalCode: | 230603452 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8047557581 | ||||||||
| FaxNumber: | 8047557586 | ||||||||
| Practice Location | |||||||||
| Address1: | 417 N 11TH ST | ||||||||
| Address2: | IM RESIDENT ACC CLINIC | ||||||||
| City: | RICHMOND | ||||||||
| State: | VA | ||||||||
| PostalCode: | 232985002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8048288786 | ||||||||
| FaxNumber: | 8048285466 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/11/2011 | ||||||||
| LastUpdateDate: | 07/07/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 0101256966 | VA | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.