Basic Information
| Provider Information | |||||||||
| NPI: | 1891792099 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JOHN | ||||||||
| FirstName: | CHERIAN | ||||||||
| MiddleName: | |||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 560 STEUBENVILLE PIKE | ||||||||
| Address2: | |||||||||
| City: | BURGETTSTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 150218539 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7249475350 | ||||||||
| FaxNumber: | 7409470206 | ||||||||
| Practice Location | |||||||||
| Address1: | 560 STEUBENVILLE PIKE | ||||||||
| Address2: | |||||||||
| City: | BURGETTSTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 150218552 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7249475053 | ||||||||
| FaxNumber: | 7249470206 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/01/2005 | ||||||||
| LastUpdateDate: | 09/12/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | MD033648E | PA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 14686 | WV | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 35054409J | OH | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RC0000X | MD033648E | PA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | 207RC0000X | 14686 | WV | N | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | 207RC0000X | 35054409J | OH | N | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 0698580 | 05 | OH | MEDICAID | P00011255 | 01 | WV | RR MEDICARE | OTHER | 0010024670008 | 05 | PA | MEDICAID | 0085888000 | 05 | WV | MEDICAID | P00011256 | 01 | PA | RR MEDICARE | OTHER | P00330359 | 01 | OH | RR MEDICARE | OTHER |