Provider Demographics
NPI:1710988936
Name:SHERIDAN, EDWARD J (MD)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:J
Last Name:SHERIDAN
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 1:1456 JACKSON PIKE
Mailing Address - Street 2:STE 2
Mailing Address - City:GALLIPOLIS
Mailing Address - State:OH
Mailing Address - Zip Code:45631-2602
Mailing Address - Country:US
Mailing Address - Phone:740-446-0112
Mailing Address - Fax:740-446-4732
Practice Address - Street 1:159 E 2ND ST
Practice Address - Street 2:
Practice Address - City:CHILLICOTHE
Practice Address - State:OH
Practice Address - Zip Code:45601-2526
Practice Address - Country:US
Practice Address - Phone:740-773-6347
Practice Address - Fax:740-773-9093
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2009-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35038030S207W00000X
WV11622207W00000X
MI4301060933207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0282671Medicaid
OH0282671Medicaid
OH4262461Medicare PIN
OH0413256Medicare ID - Type Unspecified
OH4262462Medicare PIN