Provider Demographics
NPI:1700193810
Name:NICHOLAS E SHEROCK JR DO LLC
Entity Type:Organization
Organization Name:NICHOLAS E SHEROCK JR DO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:E
Authorized Official - Last Name:SHEROCK
Authorized Official - Suffix:JR
Authorized Official - Credentials:DO
Authorized Official - Phone:330-684-4707
Mailing Address - Street 1:830 S MAIN ST
Mailing Address - Street 2:#102
Mailing Address - City:ORRVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44667-2291
Mailing Address - Country:US
Mailing Address - Phone:330-684-4707
Mailing Address - Fax:330-684-4733
Practice Address - Street 1:830 S MAIN ST
Practice Address - Street 2:#102
Practice Address - City:ORRVILLE
Practice Address - State:OH
Practice Address - Zip Code:44667-2291
Practice Address - Country:US
Practice Address - Phone:330-684-4707
Practice Address - Fax:330-684-4733
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-10
Last Update Date:2010-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34-005035207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHF80353OtherUPIN
OH1134115926OtherINDIVIDUAL NPI
OH0976252Medicaid