Provider Demographics
NPI:1598763559
Name:GRISSINGER, SHARON L (DPM)
Entity Type:Individual
Prefix:DR
First Name:SHARON
Middle Name:L
Last Name:GRISSINGER
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 FRANK ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT JOY
Mailing Address - State:PA
Mailing Address - Zip Code:17552-1422
Mailing Address - Country:US
Mailing Address - Phone:717-653-6350
Mailing Address - Fax:717-653-8044
Practice Address - Street 1:112 FRANK ST
Practice Address - Street 2:
Practice Address - City:MOUNT JOY
Practice Address - State:PA
Practice Address - Zip Code:17552-1422
Practice Address - Country:US
Practice Address - Phone:717-653-6350
Practice Address - Fax:717-653-8044
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2010-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC-003235-L213E00000X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA125433902Medicaid
PAU03004Medicare UPIN
PA125433902Medicaid