MEDICARE: DR. DOROTHY DELLA SHERWOOD M.D.

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	207RG0300X	Geriatric Medicine (Internal Medicine) Physician	H8835	TX
2	207RG0300X	Geriatric Medicine (Internal Medicine) Physician	MD159682	OR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	8AG057	OTHER	TX	BCBS

General Provider Information

NPI Number	:	1780693143
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DOROTHY DELLA SHERWOOD M.D.

Provider Business Mailing Address
First Line	:	PO BOX 1520
Second Line	:
City	:	THE DALLES
State	:	OR
Zip	:	97058-8003
Country	:	US
Telephone Number	:	541-296-7668
Fax Number	:	541-296-6431

Provider Business Practice Location Address
First Line	:	1825 E 19TH ST
Second Line	:
City	:	THE DALLES
State	:	OR
Zip	:	97058-3365
Country	:	US
Telephone Number	:	541-506-6940
Fax Number	:	541-296-2636

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

Provider Enumeration Date	:	08/05/2006
Last Update Date	:	11/07/2013

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Directions to “ DR. DOROTHY DELLA SHERWOOD M.D.” Practice Location

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