Provider Demographics
NPI:1033162136
Name:SHARP, BRIAN HOWARD (PHD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:HOWARD
Last Name:SHARP
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:MANNINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:26582-1132
Mailing Address - Country:US
Mailing Address - Phone:304-986-1753
Mailing Address - Fax:304-986-1753
Practice Address - Street 1:201 MARKET ST
Practice Address - Street 2:
Practice Address - City:MANNINGTON
Practice Address - State:WV
Practice Address - Zip Code:26582-1132
Practice Address - Country:US
Practice Address - Phone:304-986-1753
Practice Address - Fax:304-986-1753
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV638103G00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVSH2023243Medicare ID - Type UnspecifiedMEDICARE