Provider Demographics
NPI:1275595753
Name:SHARATA, HARRY H (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:HARRY
Middle Name:H
Last Name:SHARATA
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6510 GRAND TETON PLZ STE 302
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53719-1029
Mailing Address - Country:US
Mailing Address - Phone:608-239-3440
Mailing Address - Fax:608-826-0281
Practice Address - Street 1:6510 GRAND TETON PLZ
Practice Address - Street 2:SUITE 302
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53719-1029
Practice Address - Country:US
Practice Address - Phone:608-826-0285
Practice Address - Fax:608-826-0281
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-03
Last Update Date:2020-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI35716-020207N00000X
174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
No207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI000015125Medicare PIN
WI000025010Medicare PIN
WIF92036Medicare UPIN