Healthcare Provider Details

I. General information

NPI: 1780676742
Provider Name (Legal Business Name): RICHARD H SHEREFF MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2005
Last Update Date: 01/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

139 HUNTER CIR
FAYETTEVILLE NC
28304-3408
US

IV. Provider business mailing address

139 HUNTER CIR
FAYETTEVILLE NC
28304-3408
US

V. Phone/Fax

Practice location:
  • Phone: 910-323-4888
  • Fax: 910-323-9005
Mailing address:
  • Phone: 910-323-4888
  • Fax: 910-323-9005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number22276
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number22276
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: