Provider Demographics
NPI:1134178643
Name:CHERRY, SURAJ MATHEW (MD)
Entity type:Individual
Prefix:
First Name:SURAJ
Middle Name:MATHEW
Last Name:CHERRY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3505 LONE TREE WAY
Mailing Address - Street 2:SUITE 6
Mailing Address - City:ANTIOCH
Mailing Address - State:CA
Mailing Address - Zip Code:94509-6067
Mailing Address - Country:US
Mailing Address - Phone:925-778-4555
Mailing Address - Fax:925-778-3310
Practice Address - Street 1:3505 LONE TREE WAY
Practice Address - Street 2:SUITE 6
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94509-6067
Practice Address - Country:US
Practice Address - Phone:925-778-4555
Practice Address - Fax:925-778-3310
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA88726207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A887260Medicaid
I12981Medicare UPIN
CA00A887260Medicaid