Provider Demographics
NPI:1184664872
Name:SHOUKRY, SHERIF M (MD)
Entity type:Individual
Prefix:
First Name:SHERIF
Middle Name:M
Last Name:SHOUKRY
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:PO BOX 634706
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-0001
Mailing Address - Country:US
Mailing Address - Phone:865-292-3000
Mailing Address - Fax:
Practice Address - Street 1:2949 WEST FRONT STREET
Practice Address - Street 2:
Practice Address - City:RICHLANDS
Practice Address - State:VA
Practice Address - Zip Code:24641-2099
Practice Address - Country:US
Practice Address - Phone:276-596-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2011-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA101045469207P00000X
TN45866207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0075556000Medicaid
VA1184664872Medicaid
VAP00233625OtherRAILROAD MEDICARE
VA010257107Medicaid
KY7100109980Medicaid
TN1518477Medicaid
WV0075556000Medicaid
KY7100109980Medicaid
TN1518477Medicaid
TN103I930020Medicare PIN