Provider Demographics
NPI:1184602294
Name:SHERRARD, CHARLES DONALD JR (MD)
Entity type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:DONALD
Last Name:SHERRARD
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:5454 NEW CUT RD
Mailing Address - Street 2:STE 5
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40214-4271
Mailing Address - Country:US
Mailing Address - Phone:502-361-9900
Mailing Address - Fax:502-361-9947
Practice Address - Street 1:200 ABRAHAM FLEXNOR WAY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-1821
Practice Address - Country:US
Practice Address - Phone:502-587-4421
Practice Address - Fax:502-361-9947
Is Sole Proprietor?:No
Enumeration Date:2006-01-09
Last Update Date:2012-06-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KY24279207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
930059277OtherRAILROAD MEDICARE
029882600OtherFEDERAL BLACK LUNG GROUP
KY1063865OtherPASSPORT
KY64242795Medicaid
KY000000057678OtherANTHEM GROUP NUMBER
IN200206770AMedicaid
930059277OtherRAILROAD MEDICARE
KY000000057678OtherANTHEM GROUP NUMBER