Provider Demographics
NPI:1770805673
Name:CHERRY, ADAM THOMAS (PA-C)
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:THOMAS
Last Name:CHERRY
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43575 MISSION BLVD STE 716
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94539-5831
Mailing Address - Country:US
Mailing Address - Phone:408-476-0624
Mailing Address - Fax:
Practice Address - Street 1:1152 DOUGLAS ST
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632-2452
Practice Address - Country:US
Practice Address - Phone:360-940-0880
Practice Address - Fax:844-697-8702
Is Sole Proprietor?:No
Enumeration Date:2010-02-18
Last Update Date:2024-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA60549062363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2044894Medicaid
TX211997602Medicaid
TX211997605Medicaid
TX2119976001Medicaid
TX211997603Medicaid
TX211997604Medicaid
TX2119976001Medicaid
TXTXB100894Medicare PIN
TXTXB100890Medicare PIN
TX211997603Medicaid
TXTXB100878Medicare PIN