Individual
DR. MARYALICE CHENEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1100 WALNUT ST, SUITE 702, PHILADELPHIA, PA 19107-5563
(215) 923-7176
(215) 955-2404
Mailing address
1100 WALNUT ST, SUITE 702, PHILADELPHIA, PA 19107-5563
(215) 923-7176
(215) 955-2404
Taxonomy
Speciality
Code
Description
License number
State
208C00000X
Colon & Rectal Surgery Physician
Primary
MD025382E
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1119530
—
PA
Enumeration date
12/19/2006
Last updated
07/08/2007
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