Provider Demographics
NPI:1083766067
Name:DEMEHRI, SHERIAR FOOLAD
Entity Type:Individual
Prefix:DR
First Name:SHERIAR
Middle Name:FOOLAD
Last Name:DEMEHRI
Suffix:
Gender:M
Credentials:
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 1038
Mailing Address - Street 2:
Mailing Address - City:LEONARDTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20650
Mailing Address - Country:US
Mailing Address - Phone:301-475-3300
Mailing Address - Fax:301-475-3377
Practice Address - Street 1:26772 POINT LOOKOUT ROAD
Practice Address - Street 2:
Practice Address - City:LEONARDTOWN
Practice Address - State:MD
Practice Address - Zip Code:20650
Practice Address - Country:US
Practice Address - Phone:301-475-3300
Practice Address - Fax:301-475-3377
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2019-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01136213E00000X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD190728000Medicaid
B5510001OtherBCBS MD
B5510001OtherBCBS MD
U35357Medicare UPIN
MD0800430001Medicare NSC