Provider Demographics
NPI:1083720445
Name:NEIBEL-PONDEK, SHARON ELLEN (MD)
Entity Type:Individual
Prefix:DR
First Name:SHARON
Middle Name:ELLEN
Last Name:NEIBEL-PONDEK
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 1:1138 SPARROW MILL WAY
Mailing Address - Street 2:
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21015-6134
Mailing Address - Country:US
Mailing Address - Phone:410-838-0343
Mailing Address - Fax:
Practice Address - Street 1:4C NORTH AVE
Practice Address - Street 2:SUITE 403
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21014-2330
Practice Address - Country:US
Practice Address - Phone:410-838-0343
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD380382080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDD38038OtherSTATE LICENSE NUMBER
MD543711300Medicaid
MD208000000XOtherTAXONOMY NUMBER
MD522272246OtherTAX ID #
MD543711300Medicaid