Provider Demographics
NPI:1720058985
Name:WEHRMAN, SALLY R (MD)
Entity Type:Individual
Prefix:
First Name:SALLY
Middle Name:R
Last Name:WEHRMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1882 GROVEPOINTE DR
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:KY
Mailing Address - Zip Code:41042-4311
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7655 5 MILE RD
Practice Address - Street 2:SUITE 101
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45230-4326
Practice Address - Country:US
Practice Address - Phone:513-231-3345
Practice Address - Fax:513-624-2588
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35037655208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000003791OtherANTHEM INSURANCE
OH0375731Medicaid