Provider Demographics
NPI:1366550683
Name:SHERIDAN, MARTHA GRUNEWALD (MD)
Entity type:Individual
Prefix:
First Name:MARTHA GRUNEWALD
Middle Name:
Last Name:SHERIDAN
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 1:34 LAWRENCE LN
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02421-8229
Mailing Address - Country:US
Mailing Address - Phone:781-863-0518
Mailing Address - Fax:
Practice Address - Street 1:34 LAWRENCE LN
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02421-8229
Practice Address - Country:US
Practice Address - Phone:781-863-0518
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA75130208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics