Provider Demographics
NPI:1235231044
Name:SHARP, HARRY WALTON JR (DO)
Entity Type:Individual
Prefix:DR
First Name:HARRY
Middle Name:WALTON
Last Name:SHARP
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1415 MARLTON PIKE E STE LL5
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08034-2229
Mailing Address - Country:US
Mailing Address - Phone:856-285-7200
Mailing Address - Fax:856-285-7201
Practice Address - Street 1:524 WILLIAMSTOWN RD STE A
Practice Address - Street 2:
Practice Address - City:SICKLERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08081-1800
Practice Address - Country:US
Practice Address - Phone:856-728-1181
Practice Address - Fax:856-728-1182
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2019-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB02886900207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ381020OtherMEDICARE GROUP
NJ0455091OtherMEDICAID GROUP
NJ0455091OtherMEDICAID GROUP