Healthcare Provider Details

I. General information

NPI: 1104809904
Provider Name (Legal Business Name): SANDRA J HERRINGTON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/25/2005
Last Update Date: 07/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

803 W MARKET ST SUITE 100
LIMA OH
45805-2796
US

IV. Provider business mailing address

PO BOX 636930
CINCINNATI OH
45263-6930
US

V. Phone/Fax

Practice location:
  • Phone: 419-996-5063
  • Fax: 419-996-5502
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number35-087145
License Number StateOH

VII. Legacy identifiers

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

# 1
Identifier2686240
Identifier TypeMEDICAID
Identifier StateOH
Identifier Issuer
# 2
Identifier1104809904
Identifier TypeOTHER
Identifier StateMI
Identifier IssuerMI MEDICAID-OH LOCATIONS
# 3
IdentifierP00695742
Identifier TypeOTHER
Identifier StateOH
Identifier IssuerRR MEDICARE
# 4
IdentifierHE4185204
Identifier TypeOTHER
Identifier StateOH
Identifier IssuerMEDICARE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: