Basic Information
| Provider Information | |||||||||
| NPI: | 1487651469 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHEERAN | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | C | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1415 PORTLAND AVE | ||||||||
| Address2: | SUITE 240 | ||||||||
| City: | ROCHESTER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 146213038 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5855446550 | ||||||||
| FaxNumber: | 5853382997 | ||||||||
| Practice Location | |||||||||
| Address1: | 1415 PORTLAND AVE | ||||||||
| Address2: | SUITE 240 | ||||||||
| City: | ROCHESTER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 146213038 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5855446550 | ||||||||
| FaxNumber: | 5853382997 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/05/2005 | ||||||||
| LastUpdateDate: | 05/11/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/11/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208G00000X | 148925 | NY | Y | Allopathic & Osteopathic Physicians | Thoracic Surgery (Cardiothoracic Vascular Surgery) |
ID Information
| ID | Type | State | Issuer | Description | 1045207 | 05 | NY | MEDICAID |