Provider Demographics
NPI:1538359708
Name:RICHARD H SHEREFF MD PA
Entity type:Organization
Organization Name:RICHARD H SHEREFF MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY TREASURER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:SHEREFF
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:910-323-4888
Mailing Address - Street 1:139 HUNTER CIRCLE
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-3408
Mailing Address - Country:US
Mailing Address - Phone:910-323-4888
Mailing Address - Fax:910-323-9005
Practice Address - Street 1:139 HUNTER CIRCLE
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-3408
Practice Address - Country:US
Practice Address - Phone:910-323-4888
Practice Address - Fax:910-323-9005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-25
Last Update Date:2010-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC22276207NS0135X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural DermatologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC75765OtherBCBS
NC8975765Medicaid
NC201902Medicare PIN
NC8975765Medicaid