Provider Demographics
NPI:1790869311
Name:SHERWIN, JOSHUA L (MD)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:L
Last Name:SHERWIN
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 1:324 GANNETT DR STE 200
Mailing Address - Street 2:
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106-3266
Mailing Address - Country:US
Mailing Address - Phone:207-482-7800
Mailing Address - Fax:
Practice Address - Street 1:484 KING ST STE 205
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29403-6229
Practice Address - Country:US
Practice Address - Phone:330-474-3112
Practice Address - Fax:330-572-3836
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2019-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.1349862085R0202X
ME0135542085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0330880Medicaid
ME300068506Medicare ID - Type UnspecifiedRAILROAD
MEMM4903Medicare ID - Type Unspecified
ME293420099Medicaid
ME0005879263OtherAETNA/USHC
MEF61818Medicare UPIN
ME024285OtherANTHEM
MEF61818OtherHPHC
ME2323445OtherAETNA