Individual
TINISHA JORDAN CHEATHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
1701 TWIN SPRINGS RD, HALETHORPE, MD 21227-3553
(410) 737-5000
Mailing address
2101 E JEFFERSON ST, KAISER PERMANENTE MEDICARE ENROLLMENT, ROCKVILLE, MD 20852-4908
(301) 816-2424
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
0102201407
VA
207Q00000X
Family Medicine Physician
DO34139
DC
207Q00000X
Family Medicine Physician
Primary
H0059884
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
403759600
—
MD
Enumeration date
06/03/2006
Last updated
06/16/2021
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