Provider Demographics
NPI:1326214198
Name:SHARPE, STEPHANIE C (MD)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:C
Last Name:SHARPE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:822 S 500 W
Mailing Address - Street 2:PO BOX 609
Mailing Address - City:PORTLAND
Mailing Address - State:IN
Mailing Address - Zip Code:47371-8377
Mailing Address - Country:US
Mailing Address - Phone:260-726-9027
Mailing Address - Fax:260-726-9529
Practice Address - Street 1:430 W VOTAW ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:IN
Practice Address - Zip Code:47371-1302
Practice Address - Country:US
Practice Address - Phone:260-726-9027
Practice Address - Fax:260-726-9529
Is Sole Proprietor?:No
Enumeration Date:2008-05-01
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01051569A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
INH10383Medicare UPIN