Provider Demographics
NPI:1629048541
Name:SHERER, CLARK (MD)
Entity Type:Individual
Prefix:
First Name:CLARK
Middle Name:
Last Name:SHERER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 WILLIAMSON ST
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH
Mailing Address - State:NJ
Mailing Address - Zip Code:07202-3625
Mailing Address - Country:US
Mailing Address - Phone:908-325-6322
Mailing Address - Fax:908-325-6343
Practice Address - Street 1:225 WILLIAMSON ST
Practice Address - Street 2:
Practice Address - City:ELIZABETH
Practice Address - State:NJ
Practice Address - Zip Code:07202-3625
Practice Address - Country:US
Practice Address - Phone:908-325-6322
Practice Address - Fax:908-325-6343
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-24
Last Update Date:2010-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA53108207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0969109Medicaid
A61397Medicare UPIN
476575Medicare ID - Type Unspecified