Basic Information
Provider Information
NPI: 1225094592
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SHERMAN
FirstName: HOWARD
MiddleName: B
NamePrefix:  
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 9 HEALTHCARE DRIVE
Address2: SUITE 201
City: BIDDEFORD
State: ME
PostalCode: 040053747
CountryCode: US
TelephoneNumber: 2072829080
FaxNumber: 2072829180
Practice Location
Address1: 9 HEALTHCARE DRIVE
Address2: SUITE 105
City: BIDDEFORD
State: ME
PostalCode: 040059404
CountryCode: US
TelephoneNumber: 2072823666
FaxNumber: 2072824578
Other Information
ProviderEnumerationDate: 04/25/2006
LastUpdateDate: 01/31/2011
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RC0000X014905MEY Allopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease

ID Information
IDTypeStateIssuerDescription
27426009905ME MEDICAID
02535801MEANTHEMOTHER
203722001MEAETNAOTHER
62013930101MECIGNAOTHER
MM732601MEHARVARD PILGRIMOTHER


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