Provider Demographics
NPI:1932107265
Name:MERKIN, SANFORD SHELDON (DPM)
Entity Type:Individual
Prefix:DR
First Name:SANFORD
Middle Name:SHELDON
Last Name:MERKIN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7640 SYLVANIA AVE
Mailing Address - Street 2:SUITE C-2
Mailing Address - City:SYLVANIA
Mailing Address - State:OH
Mailing Address - Zip Code:43560-9729
Mailing Address - Country:US
Mailing Address - Phone:419-882-7828
Mailing Address - Fax:419-824-0026
Practice Address - Street 1:7640 SYLVANIA AVE
Practice Address - Street 2:SUITE C-2
Practice Address - City:SYLVANIA
Practice Address - State:OH
Practice Address - Zip Code:43560-9729
Practice Address - Country:US
Practice Address - Phone:419-882-7828
Practice Address - Fax:419-824-0026
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-11
Last Update Date:2013-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36-002051213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0550149Medicaid
OH00641OtherPARAMOUNT
OH480021355OtherMEDICARE RAILROAD
OH0550149Medicaid
OH00641OtherPARAMOUNT