Provider Demographics
NPI:1629050794
Name:SHERMAN, RICHARD LAWRENCE (DO)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:LAWRENCE
Last Name:SHERMAN
Suffix:
Gender:M
Credentials:DO
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 14611
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29610-4611
Mailing Address - Country:US
Mailing Address - Phone:864-306-0966
Mailing Address - Fax:864-306-2544
Practice Address - Street 1:3523 PELHAM RD
Practice Address - Street 2:SUITE C
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-4191
Practice Address - Country:US
Practice Address - Phone:864-306-0966
Practice Address - Fax:864-306-2544
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-15
Last Update Date:2021-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC0334207QA0401X, 207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC003445Medicaid
SC003445Medicaid
D20077Medicare UPIN