Provider Demographics
NPI:1538478029
Name:SHARON FOSTER GARDEPE, M.D., P.C.
Entity Type:Organization
Organization Name:SHARON FOSTER GARDEPE, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:FOSTER
Authorized Official - Last Name:GARDEPE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:256-536-0992
Mailing Address - Street 1:201 SIVLEY RD SW
Mailing Address - Street 2:SUITE 510
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-5138
Mailing Address - Country:US
Mailing Address - Phone:256-536-0992
Mailing Address - Fax:256-265-2765
Practice Address - Street 1:201 SIVLEY RD SW
Practice Address - Street 2:SUITE 510
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-5134
Practice Address - Country:US
Practice Address - Phone:256-536-0992
Practice Address - Fax:256-265-2765
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-30
Last Update Date:2015-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4558207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000013501Medicaid
0004003541OtherAETNA
AL51013501OtherBLUECROSS AND BLUESHIELD
AL000013501Medicaid
0004003541OtherAETNA