Provider Demographics
NPI:1417058645
Name:KOFOED, SHARON E (MD)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:E
Last Name:KOFOED
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 1:135 COMMONWEALTH DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-4831
Mailing Address - Country:US
Mailing Address - Phone:864-675-1190
Mailing Address - Fax:
Practice Address - Street 1:135 COMMONWEALTH DR
Practice Address - Street 2:SUITE 300
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-4831
Practice Address - Country:US
Practice Address - Phone:864-675-1190
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2014-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC166856207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCG27416Medicare UPIN
SC8157Medicare ID - Type UnspecifiedMEDICARE