MEDICARE: DR. KATHLEEN M SHERIDAN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	MD19898	ME
2	207V00000X	Obstetrics & Gynecology Physician	270045	MA
3	207V00000X	Obstetrics & Gynecology Physician	MD428219	PA

General Provider Information

NPI Number	:	1720058712
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KATHLEEN M SHERIDAN MD

Provider Business Mailing Address
First Line	:	1575 HIGHLANDS DR STE 101
Second Line	:
City	:	LITITZ
State	:	PA
Zip	:	17543-7507
Country	:	US
Telephone Number	:	717-393-1338
Fax Number	:	717-627-1817

Provider Business Practice Location Address
First Line	:	1575 HIGHLANDS DR STE 101
Second Line	:
City	:	LITITZ
State	:	PA
Zip	:	17543-7507
Country	:	US
Telephone Number	:	717-393-1338
Fax Number	:	717-627-1817

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/24/2006
Last Update Date	:	03/21/2024

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