Provider Demographics
NPI:1083674709
Name:SHERMAN, MARY B (MD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:B
Last Name:SHERMAN
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:PO BOX 2685
Mailing Address - Street 2:
Mailing Address - City:SEAL BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90740-1685
Mailing Address - Country:US
Mailing Address - Phone:562-493-9581
Mailing Address - Fax:
Practice Address - Street 1:1661 GOLDEN RAIN RD
Practice Address - Street 2:
Practice Address - City:SEAL BEACH
Practice Address - State:CA
Practice Address - Zip Code:90740-4907
Practice Address - Country:US
Practice Address - Phone:562-493-9581
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG37222207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG37222Medicare ID - Type Unspecified
CAF11955Medicare UPIN