Provider Demographics
NPI:1790793917
Name:CLARA JACKSON SCHERMERHORN, MD, PHD, LLC
Entity Type:Organization
Organization Name:CLARA JACKSON SCHERMERHORN, MD, PHD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:CLARA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:SCHERMERHORN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:419-334-9716
Mailing Address - Street 1:2539 HAYES AVE
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:OH
Mailing Address - Zip Code:43420-2638
Mailing Address - Country:US
Mailing Address - Phone:419-334-9716
Mailing Address - Fax:419-355-8171
Practice Address - Street 1:2539 HAYES AVE
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:OH
Practice Address - Zip Code:43420-2638
Practice Address - Country:US
Practice Address - Phone:419-334-9716
Practice Address - Fax:419-355-8171
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-088014207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Not Answered208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH35-088014OtherOHIO LICENSE