Provider Demographics
NPI:1073755534
Name:SHERKOW, COLLEEN (MD)
Entity Type:Individual
Prefix:DR
First Name:COLLEEN
Middle Name:
Last Name:SHERKOW
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 1:863 N MAIN STREET EXT
Mailing Address - Street 2:SUITE 103
Mailing Address - City:WALLINGFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06492-2434
Mailing Address - Country:US
Mailing Address - Phone:203-694-5500
Mailing Address - Fax:203-694-5520
Practice Address - Street 1:863 N MAIN STREET EXT
Practice Address - Street 2:SUITE 103
Practice Address - City:WALLINGFORD
Practice Address - State:CT
Practice Address - Zip Code:06492-2434
Practice Address - Country:US
Practice Address - Phone:203-694-5500
Practice Address - Fax:203-694-5520
Is Sole Proprietor?:No
Enumeration Date:2009-03-30
Last Update Date:2013-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT051464207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008046671Medicaid
CT1073755534OtherANTHEM BCBS