Provider Demographics
NPI:1780693143
Name:SHERWOOD, DOROTHY DELLA (MD)
Entity type:Individual
Prefix:DR
First Name:DOROTHY
Middle Name:DELLA
Last Name:SHERWOOD
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:PO BOX 1520
Mailing Address - Street 2:
Mailing Address - City:THE DALLES
Mailing Address - State:OR
Mailing Address - Zip Code:97058-8003
Mailing Address - Country:US
Mailing Address - Phone:541-296-7668
Mailing Address - Fax:541-296-6431
Practice Address - Street 1:1825 E 19TH ST
Practice Address - Street 2:
Practice Address - City:THE DALLES
Practice Address - State:OR
Practice Address - Zip Code:97058-3365
Practice Address - Country:US
Practice Address - Phone:541-506-6940
Practice Address - Fax:541-296-2636
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2013-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH8835207RG0300X
ORMD159682207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1780693143Medicaid
OR218105Medicaid
TX8AG057OtherBCBS
OR383993Medicare PIN
ORR172048Medicare PIN
TX8AG057OtherBCBS
OR218105Medicaid