Provider Demographics
NPI:1982662706
Name:SHERMAN, NATHANIEL III (MD)
Entity Type:Individual
Prefix:
First Name:NATHANIEL
Middle Name:
Last Name:SHERMAN
Suffix:III
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 1:4750 HEMPSTEAD STATION DR
Mailing Address - Street 2:
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45429-5164
Mailing Address - Country:US
Mailing Address - Phone:800-875-0136
Mailing Address - Fax:937-619-4304
Practice Address - Street 1:629 N SANDUSKY AVE
Practice Address - Street 2:
Practice Address - City:BUCYRUS
Practice Address - State:OH
Practice Address - Zip Code:44820-1821
Practice Address - Country:US
Practice Address - Phone:419-562-4677
Practice Address - Fax:419-562-0987
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2009-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35049769S207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
POO274620OtherRR MEDICARE FOR BUCYRUS
OH000000356305OtherBCBS FOR BUCYRUS
OH000000317863OtherBCBS
00000316741OtherBCBS MADISON
P00273721OtherRR MEDICARE
OHP00449163OtherMEDICARE RAIL ROAD
000000315930OtherHOCKING BCBS
OH000000543500OtherANTHEM BCBS
OH0569059Medicaid
P00095260OtherRAIL ROAD MADISON
000000384397OtherBCBS
OHP00449163OtherMEDICARE RAIL ROAD
OH000000543500OtherANTHEM BCBS
OH4151993Medicare PIN
SH0790038Medicare PIN
P00273721OtherRR MEDICARE
B46095Medicare UPIN
SH4151992Medicare PIN
OHSH0790037Medicare PIN
000000315930OtherHOCKING BCBS