Basic Information
| Provider Information | |||||||||
| NPI: | 1548294739 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DENICK | ||||||||
| FirstName: | CHERYL | ||||||||
| MiddleName: | ANN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | ONE MEDICAL CENTER BLVD | ||||||||
| Address2: | |||||||||
| City: | UPLAND | ||||||||
| State: | PA | ||||||||
| PostalCode: | 19013 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6104476370 | ||||||||
| FaxNumber: | 6104476373 | ||||||||
| Practice Location | |||||||||
| Address1: | 2401 PARK DR STE 101 | ||||||||
| Address2: | |||||||||
| City: | HARRISBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 171109303 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7176869842 | ||||||||
| FaxNumber: | 8448038108 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/11/2006 | ||||||||
| LastUpdateDate: | 03/11/2021 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 03/11/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 0101251886 | VA | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 01863869-01 | 01 | PA | AMERICHOICE | OTHER | 20045115 | 01 | PA | AMERIHEALTH MERCY | OTHER | 810300818 | 01 | PA | PHCS | OTHER | 0533292000 | 01 | PA | KEYSTONE IBC | OTHER | 07645 | 01 | PA | HEALTH PARTNERS | OTHER | 1974042 | 01 | PA | FIRST HEALTH | OTHER | 0018638690003 | 05 | PA | MEDICAID | 01863869-02 | 01 | PA | AMERICHOICE | OTHER | 698314 | 01 | PA | HIGHMARK BLUE SHIELD | OTHER | 0018638690002 | 05 | PA | MEDICAID | 1090988 | 01 | PA | KEYSTONE MERCY | OTHER | 7887164 | 01 | PA | CIGNA | OTHER | 01863869-03 | 01 | PA | AMERICHOICE | OTHER | 0018638690004 | 05 | PA | MEDICAID | 698314 | 01 | PA | PERSONAL CHOICE | OTHER | 452729 | 01 | PA | AETNA CONTRACT | OTHER |