Provider Demographics
NPI:1346237682
Name:GRUNEBERG, SHERRI L (MD)
Entity Type:Individual
Prefix:DR
First Name:SHERRI
Middle Name:L
Last Name:GRUNEBERG
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 1:405 FREDERICK RD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:CATONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-4645
Mailing Address - Country:US
Mailing Address - Phone:410-788-6565
Mailing Address - Fax:410-747-4688
Practice Address - Street 1:405 FREDERICK RD
Practice Address - Street 2:SUITE 210
Practice Address - City:CATONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21228-4645
Practice Address - Country:US
Practice Address - Phone:410-788-6565
Practice Address - Fax:410-747-4688
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0055811208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD798LH117Medicare ID - Type Unspecified
MDH97055Medicare UPIN