Provider Demographics
NPI:1780647636
Name:DORMAN, SHARON L (DO)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:L
Last Name:DORMAN
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 1:2108 SR 113 EAST
Mailing Address - Street 2:
Mailing Address - City:MILAN
Mailing Address - State:OH
Mailing Address - Zip Code:44846
Mailing Address - Country:US
Mailing Address - Phone:419-499-2600
Mailing Address - Fax:419-499-3060
Practice Address - Street 1:2108 SR 113 EAST
Practice Address - Street 2:
Practice Address - City:MILAN
Practice Address - State:OH
Practice Address - Zip Code:44846
Practice Address - Country:US
Practice Address - Phone:419-499-2600
Practice Address - Fax:419-499-3060
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34006050207V00000X
SD5000207V00000X
SC0458207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0307411Medicaid
OH0307411Medicaid
G09719Medicare UPIN