Provider Demographics
NPI:1356304315
Name:BOLSAR, SHARON A (PA-C)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:A
Last Name:BOLSAR
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 E BROWN ST
Mailing Address - Street 2:POCONO HEALTHCARE MGMT. - PROFESSIONAL BLDG.
Mailing Address - City:EAST STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18301-3006
Mailing Address - Country:US
Mailing Address - Phone:570-420-4997
Mailing Address - Fax:570-476-3754
Practice Address - Street 1:100 COMMUNITY DR
Practice Address - Street 2:MOUNTAIN FAMILY CARE. SUITE 102
Practice Address - City:TOBYHANNA
Practice Address - State:PA
Practice Address - Zip Code:18466-8985
Practice Address - Country:US
Practice Address - Phone:570-895-2300
Practice Address - Fax:570-895-4270
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2010-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA003362L363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
P37274Medicare UPIN
PA069937PZPMedicare ID - Type Unspecified