Provider Demographics
NPI:1780676742
Name:SHEREFF, RICHARD H (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:H
Last Name:SHEREFF
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 1:139 HUNTER CIR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-3408
Mailing Address - Country:US
Mailing Address - Phone:910-323-4888
Mailing Address - Fax:910-323-9005
Practice Address - Street 1:139 HUNTER CIR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-3408
Practice Address - Country:US
Practice Address - Phone:910-323-4888
Practice Address - Fax:910-323-9005
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2012-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC22276207N00000X, 207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC75765OtherBCBS
NC56-1255529OtherTAX ID#
NC8975765Medicaid
NC56-1255529OtherTAX ID#
NC8975765Medicaid