Provider Demographics
NPI:1366419624
Name:IKALOWYCH, SHERRY ZILBERT (MD)
Entity type:Individual
Prefix:
First Name:SHERRY
Middle Name:ZILBERT
Last Name:IKALOWYCH
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 1:1608 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:SC
Mailing Address - Zip Code:29526-3572
Mailing Address - Country:US
Mailing Address - Phone:432-484-7008
Mailing Address - Fax:
Practice Address - Street 1:1608 MAIN ST
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:SC
Practice Address - Zip Code:29526-3572
Practice Address - Country:US
Practice Address - Phone:843-248-4700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-07
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC30674207R00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC306742Medicaid
NC1366419624Medicaid
SC306742Medicaid
I43621Medicare UPIN
NC1366419624Medicaid
NC2047081Medicare PIN