Provider Demographics
NPI:1780762278
Name:SHERARD, PHILLIP A (MD,MPH)
Entity type:Individual
Prefix:
First Name:PHILLIP
Middle Name:A
Last Name:SHERARD
Suffix:
Gender:M
Credentials:MD,MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6955 FOOTHILL BVLD SUITE 200
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94605-3429
Mailing Address - Country:US
Mailing Address - Phone:510-567-5939
Mailing Address - Fax:
Practice Address - Street 1:6955 FOOTHILL BVLD SUITE 200
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94605-3429
Practice Address - Country:US
Practice Address - Phone:510-567-5939
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2013-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC37385208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C373850Medicaid
A36599Medicare UPIN
CA00C373850Medicaid