Healthcare Provider Details

I. General information

NPI: 1093042996
Provider Name (Legal Business Name): THERESA T. SHERROD M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: THERESA T. HOLLAND M.D.

II. Dates (important events)

Enumeration Date: 11/13/2009
Last Update Date: 12/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8561 FENTON ST SUITE 250
SILVER SPRING MD
20910-4455
US

IV. Provider business mailing address

8561 FENTON ST SUITE 250
SILVER SPRING MD
20910-4455
US

V. Phone/Fax

Practice location:
  • Phone: 240-821-1222
  • Fax: 240-821-1227
Mailing address:
  • Phone: 240-821-1222
  • Fax: 240-821-1227

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZD0900X
TaxonomyDermatopathology (Pathology) Physician
License NumberD57860
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code207ZD0900X
TaxonomyDermatopathology (Pathology) Physician
License NumberD0053860
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code207ZD0900X
TaxonomyDermatopathology (Pathology) Physician
License Number0101032608
License Number StateVA
# 4
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberD0053860
License Number StateMD
# 5
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number0101032608
License Number StateVA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: