Provider Demographics
NPI:1861576530
Name:CHERNUKHA, KONSTANTIN V (MD)
Entity type:Individual
Prefix:
First Name:KONSTANTIN
Middle Name:V
Last Name:CHERNUKHA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2450 W HUNTING PARK AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19129-1302
Mailing Address - Country:US
Mailing Address - Phone:215-707-7237
Mailing Address - Fax:215-707-9389
Practice Address - Street 1:3401 N BROAD ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19140-5103
Practice Address - Country:US
Practice Address - Phone:215-707-7237
Practice Address - Fax:215-707-9389
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2018-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC1-00104272085R0202X
MDD00734962085R0202X
PAMD4191552085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAMD419155OtherMEDICAL LICENSE
MDD0073496OtherLICENSE
MDD0073496OtherLICENSE