Healthcare Provider Details

I. General information

NPI: 1780615559
Provider Name (Legal Business Name): JOHN SHERWOOD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 12/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 SAM PERRY BLVD SUITE 211
FREDERICKSBURG VA
22401-4467
US

IV. Provider business mailing address

PO BOX 845
FREDERICKSBURG VA
22404-0845
US

V. Phone/Fax

Practice location:
  • Phone: 540-372-7792
  • Fax: 540-372-2073
Mailing address:
  • Phone: 540-372-7792
  • Fax: 540-372-2073

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberD63281
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number0101240870
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number0101240870
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: