Provider Demographics
NPI:1477856912
Name:MICHAEL R SHARON, MD PC
Entity Type:Organization
Organization Name:MICHAEL R SHARON, MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:R
Authorized Official - Last Name:SHARON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-872-0888
Mailing Address - Street 1:520 HARTFORD TPKE UNIT P
Mailing Address - Street 2:
Mailing Address - City:VERNON
Mailing Address - State:CT
Mailing Address - Zip Code:06066-5042
Mailing Address - Country:US
Mailing Address - Phone:860-872-0888
Mailing Address - Fax:860-872-8940
Practice Address - Street 1:520 HARTFORD TPKE UNIT P
Practice Address - Street 2:
Practice Address - City:VERNON
Practice Address - State:CT
Practice Address - Zip Code:06066-5042
Practice Address - Country:US
Practice Address - Phone:860-872-0888
Practice Address - Fax:860-872-8940
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-06
Last Update Date:2010-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT012493OtherSTATE LISCENCE
CT110000492Medicare PIN
CTC59573Medicare UPIN