Provider Demographics
NPI:1700937786
Name:SHERMAN, MARY B (PA-C,MHP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:B
Last Name:SHERMAN
Suffix:
Gender:F
Credentials:PA-C,MHP
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 118008
Mailing Address - Street 2:
Mailing Address - City:N CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29423-8008
Mailing Address - Country:US
Mailing Address - Phone:843-572-7727
Mailing Address - Fax:
Practice Address - Street 1:2102 OTRANTO BLVD
Practice Address - Street 2:STE.A
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-9841
Practice Address - Country:US
Practice Address - Phone:843-306-4224
Practice Address - Fax:843-863-1830
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2016-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC52-00503363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCSC07135282Medicare PIN
SC588037Medicare UPIN
SCSC07135277Medicare PIN