Provider Demographics
NPI:1164496782
Name:SHERRY, GREGORY J (MD)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:J
Last Name:SHERRY
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 1:350 HOSPITAL WAY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SOMERSET
Mailing Address - State:KY
Mailing Address - Zip Code:42503-2872
Mailing Address - Country:US
Mailing Address - Phone:606-451-2662
Mailing Address - Fax:606-451-2641
Practice Address - Street 1:350 HOSPITAL WAY
Practice Address - Street 2:SUITE 100
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42503-2872
Practice Address - Country:US
Practice Address - Phone:606-451-2662
Practice Address - Fax:606-451-2641
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY23467207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
1183695OtherCHA
KY64234677Medicaid
000000054064OtherANTHEM
5993115OtherAETNA
5125849OtherCCN
C04316OtherCUMBERLAND HEALTHCARE
1183695OtherCHA
$$$$$$$$$-00OtherOHIO WORKERS COMP
000000054064OtherANTHEM