Provider Demographics
NPI:1871556712
Name:SHARON L DORMAN DO AND ASSOCIATES INC
Entity type:Organization
Organization Name:SHARON L DORMAN DO AND ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:L
Authorized Official - Last Name:DORMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:419-499-2600
Mailing Address - Street 1:2108 S R 113 EAST
Mailing Address - Street 2:
Mailing Address - City:MILAN
Mailing Address - State:OH
Mailing Address - Zip Code:44846
Mailing Address - Country:US
Mailing Address - Phone:419-499-2600
Mailing Address - Fax:419-499-3060
Practice Address - Street 1:2108 S R 113 EAST
Practice Address - Street 2:
Practice Address - City:MILAN
Practice Address - State:OH
Practice Address - Zip Code:44846
Practice Address - Country:US
Practice Address - Phone:419-499-2600
Practice Address - Fax:419-499-3060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34006050207V00000X
OH50000956363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Not Answered363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0307411Medicaid