Provider Demographics
NPI:1568453868
Name:SINGLETON, SHARON J (MD)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:J
Last Name:SINGLETON
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 1:1717 S CALHOUN ST
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46802-5257
Mailing Address - Country:US
Mailing Address - Phone:260-458-2641
Mailing Address - Fax:
Practice Address - Street 1:1717 S CALHOUN ST
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46802-5257
Practice Address - Country:US
Practice Address - Phone:260-458-2641
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-04
Last Update Date:2018-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01054526A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000278782OtherBLUE CROSS BLUE SHIELD
INP00967450OtherRAILROAD MEDICARE
IN200280880Medicaid
INM400048182Medicare PIN
INP00967450OtherRAILROAD MEDICARE
H44219Medicare UPIN
IN925510BBMedicare PIN
INM400048182Medicare PIN
IN925500FFMedicare PIN