Provider Demographics
NPI:1427135334
Name:SHERMAN, WARREN (MD)
Entity type:Individual
Prefix:DR
First Name:WARREN
Middle Name:
Last Name:SHERMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 MARYS AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12401-5896
Mailing Address - Country:US
Mailing Address - Phone:845-339-3663
Mailing Address - Fax:845-339-3620
Practice Address - Street 1:111 MARYS AVE STE 3
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-5896
Practice Address - Country:US
Practice Address - Phone:845-339-3663
Practice Address - Fax:845-339-3620
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY135081207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00883963Medicaid
NY42D341Medicare ID - Type Unspecified
NY00883963Medicaid