Provider Demographics
NPI:1104809904
Name:HERRINGTON, SANDRA J (MD)
Entity type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:J
Last Name:HERRINGTON
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 636930
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-6930
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:803 W MARKET ST
Practice Address - Street 2:SUITE 100
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45805-2796
Practice Address - Country:US
Practice Address - Phone:419-996-5063
Practice Address - Fax:419-996-5502
Is Sole Proprietor?:No
Enumeration Date:2005-11-25
Last Update Date:2016-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-0871452085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2686240Medicaid
MI1104809904OtherMI MEDICAID-OH LOCATIONS
OHP00695742OtherRR MEDICARE
OHHE4185204OtherMEDICARE
OHH418700Medicare PIN
OHI54853Medicare UPIN