Provider Demographics
NPI:1982896858
Name:SHERLOCK, KATHRYN LEE (MD)
Entity type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:LEE
Last Name:SHERLOCK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:312 10TH ST
Mailing Address - Street 2:
Mailing Address - City:FAIRMONT
Mailing Address - State:WV
Mailing Address - Zip Code:26554-3611
Mailing Address - Country:US
Mailing Address - Phone:304-366-2818
Mailing Address - Fax:304-366-7614
Practice Address - Street 1:1 MEDICAL CENTER DRIVE
Practice Address - Street 2:WVU SCHOOL OF MEDICINE DEPT OF PEDIATRICS
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26506
Practice Address - Country:US
Practice Address - Phone:304-293-1198
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-15
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV22918208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics