Provider Demographics
NPI:1669463527
Name:JOHNSON, SHERRY L (DO)
Entity Type:Individual
Prefix:DR
First Name:SHERRY
Middle Name:L
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:424 WARDS CORNER RD STE 200
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:45140-6966
Mailing Address - Country:US
Mailing Address - Phone:513-707-4041
Mailing Address - Fax:513-576-1020
Practice Address - Street 1:2055 HOSPITAL DR STE 220
Practice Address - Street 2:
Practice Address - City:BATAVIA
Practice Address - State:OH
Practice Address - Zip Code:45103-1969
Practice Address - Country:US
Practice Address - Phone:513-732-0870
Practice Address - Fax:513-732-0873
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34008552207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2609832Medicaid
OHJO2031003Medicare PIN
OHJO2031004Medicare PIN
OHJO2031001Medicare PIN
OH2609832Medicaid