Provider Demographics
NPI:1386749109
Name:SHERER, RISA GALE (DPM)
Entity type:Individual
Prefix:
First Name:RISA
Middle Name:GALE
Last Name:SHERER
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4660 WILKENS AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21229-4848
Mailing Address - Country:US
Mailing Address - Phone:410-242-7066
Mailing Address - Fax:410-242-4126
Practice Address - Street 1:4660 WILKENS AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21229-4848
Practice Address - Country:US
Practice Address - Phone:410-242-7066
Practice Address - Fax:410-242-4126
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2007-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01283213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC30650004OtherBLUE SHIELD DC
MDS128GI82075401OtherBLUE SHIELD
MHK924GI82075402OtherBLUE SHIELD
MD0470210002Medicare NSC
MDCB1030 480028822Medicare PIN
MDU77076Medicare UPIN
MDS128GI82075401OtherBLUE SHIELD
MDK924347ZMedicare UPIN