Basic Information
| Provider Information | |||||||||
| NPI: | 1295774891 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | EBY | ||||||||
| FirstName: | CHERISH | ||||||||
| MiddleName: | DIVINA | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 785 5TH AVENUE | ||||||||
| Address2: | SUITE 3 | ||||||||
| City: | CHAMBERSBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 172014232 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7172639555 | ||||||||
| FaxNumber: | 7172174217 | ||||||||
| Practice Location | |||||||||
| Address1: | 12 ST PAUL DR STE 207 | ||||||||
| Address2: | |||||||||
| City: | CHAMBERSBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 172011035 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7172176882 | ||||||||
| FaxNumber: | 7172176883 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/06/2006 | ||||||||
| LastUpdateDate: | 03/18/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/18/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | MA003067L | PA | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical | 363A00000X | C0002427 | MD | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363AS0400X | MA003067L | PA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical |
ID Information
| ID | Type | State | Issuer | Description | 103150701 | 05 | PA | MEDICAID | 867633 | 01 | PA | MEDICARE GROUP # | OTHER | ME0756847 | 01 | PA | DEA | OTHER | 25-1716306 | 01 | PA | INTERGROUP | OTHER | MA003067L | 01 | PA | LICENSE | OTHER | 50089803 | 01 | PA | CAPITAL BLUECROSS | OTHER | 25-1716306 | 01 | PA | HEALTHNET/TRICARE | OTHER |