Basic Information
| Provider Information | |||||||||
| NPI: | 1023320868 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SHERATON | ||||||||
| FirstName: | MACK | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | SARANGI | ||||||||
| OtherFirstName: | MANAS | ||||||||
| OtherMiddleName: | RANJAN | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 4002 LAKEVIEW LN | ||||||||
| Address2: | |||||||||
| City: | MC DONALD | ||||||||
| State: | PA | ||||||||
| PostalCode: | 150573060 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8103996663 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 148 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | WINTERSVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 439533734 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7403462702 | ||||||||
| FaxNumber: | 7403462645 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/09/2010 | ||||||||
| LastUpdateDate: | 08/16/2022 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | M | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | Y | ||||||||
| IsOrganizationSubpart: | |||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 04/10/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 91796 | GA | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | 26541 | WV | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207Q00000X | 430109350 | MI | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 35.122759 | OH | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0098804 | 05 | OH | MEDICAID |