Provider Demographics
NPI:1548243926
Name:SHARVELLE, DEREK J (MD)
Entity Type:Individual
Prefix:DR
First Name:DEREK
Middle Name:J
Last Name:SHARVELLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 472
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47308-0472
Mailing Address - Country:US
Mailing Address - Phone:765-286-8888
Mailing Address - Fax:765-747-7962
Practice Address - Street 1:3746 ROME DR
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47905-4489
Practice Address - Country:US
Practice Address - Phone:765-449-3937
Practice Address - Fax:765-449-5856
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN01020187207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
B29519Medicare UPIN
IN228780CMedicare ID - Type Unspecified
IN228800CMedicare ID - Type Unspecified
IN228830CMedicare ID - Type Unspecified