Provider Demographics
NPI:1033166525
Name:HOCKENBERRY, SHERRY (MD)
Entity Type:Individual
Prefix:
First Name:SHERRY
Middle Name:
Last Name:HOCKENBERRY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 WILDWOOD RD
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:PA
Mailing Address - Zip Code:15059-2201
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1995 E STATE ST
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OH
Practice Address - Zip Code:44460-2423
Practice Address - Country:US
Practice Address - Phone:330-332-1551
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-28
Last Update Date:2010-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35069351H207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2535224Medicaid
OHP00285347OtherMEDICARE RR-GA
OH942460636908OtherCARESOURCE
OHHO4131092Medicare ID - Type Unspecified
OH2535224Medicaid