Provider Demographics
NPI:1013984525
Name:SHERIDAN, MARK F (MD)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:F
Last Name:SHERIDAN
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 1:2585 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25703-1642
Mailing Address - Country:US
Mailing Address - Phone:304-697-1396
Mailing Address - Fax:304-697-2086
Practice Address - Street 1:#3 STONECREST DR
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25701
Practice Address - Country:US
Practice Address - Phone:304-522-6388
Practice Address - Fax:304-522-8040
Is Sole Proprietor?:No
Enumeration Date:2006-03-02
Last Update Date:2016-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV19499207Y00000X
OH350788785207Y00000X
KY37594207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64942527Medicaid
OH2091909Medicaid
WV0101257000Medicaid
KY64942527Medicaid
WV9299541Medicare PIN
OH2091909Medicaid
SH0865891Medicare PIN
G27977Medicare UPIN
040012799Medicare PIN
WVCI1467Medicare PIN