Provider Demographics
NPI:1083631683
Name:SHERIDAN, JOHN M (DO)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:M
Last Name:SHERIDAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 NORTHRIDGE LN
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:24450-3399
Mailing Address - Country:US
Mailing Address - Phone:540-464-8700
Mailing Address - Fax:540-464-1362
Practice Address - Street 1:25 NORTHRIDGE LN
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:VA
Practice Address - Zip Code:24450-3399
Practice Address - Country:US
Practice Address - Phone:540-464-8700
Practice Address - Fax:540-464-1362
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2017-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB 42440207P00000X
PAOS-004961-L207P00000X
VA0102034358207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA005848211Medicaid
WV0042653-000Medicaid
VA005861411Medicaid
VA005848211Medicaid
WV0042653-000Medicaid
VA005861411Medicaid