Provider Demographics
NPI:1497773998
Name:SCHERMERHORN, CLARA MARIE (MD)
Entity Type:Individual
Prefix:DR
First Name:CLARA
Middle Name:MARIE
Last Name:SCHERMERHORN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:CLARA
Other - Middle Name:MARIE
Other - Last Name:JACKSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2539 HAYES AVE
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:OH
Mailing Address - Zip Code:43420-2638
Mailing Address - Country:US
Mailing Address - Phone:419-334-9716
Mailing Address - Fax:419-333-8171
Practice Address - Street 1:2539 HAYES AVE
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:OH
Practice Address - Zip Code:43420-2638
Practice Address - Country:US
Practice Address - Phone:419-334-9716
Practice Address - Fax:419-333-8171
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2013-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-088014207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH35-088014OtherOHIO MEDICAL LICENSE