Provider Demographics
NPI:1427163435
Name:SHERWOOD, DAVID E
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:E
Last Name:SHERWOOD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 CENTURY HILL DR
Mailing Address - Street 2:
Mailing Address - City:LATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12110-2162
Mailing Address - Country:US
Mailing Address - Phone:518-783-5563
Mailing Address - Fax:518-785-5708
Practice Address - Street 1:10 CENTURY HILL DR
Practice Address - Street 2:
Practice Address - City:LATHAM
Practice Address - State:NY
Practice Address - Zip Code:12110-2162
Practice Address - Country:US
Practice Address - Phone:518-783-5563
Practice Address - Fax:518-785-5708
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY218459-12080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000496757001OtherBLUE SHIELD OF NENY
NY02094695Medicaid
NY349679OtherMVP
NY10044836OtherCDPHP