Provider Demographics
NPI:1679851802
Name:JOSEPH, SHAREN (MD)
Entity Type:Individual
Prefix:
First Name:SHAREN
Middle Name:
Last Name:JOSEPH
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 1:3740 W SYLVANIA AVE
Mailing Address - Street 2:SUITE 250
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43623-4461
Mailing Address - Country:US
Mailing Address - Phone:419-473-6670
Mailing Address - Fax:419-473-9959
Practice Address - Street 1:3740 W SYLVANIA AVE
Practice Address - Street 2:SUITE 250
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43623-4461
Practice Address - Country:US
Practice Address - Phone:419-473-6670
Practice Address - Fax:419-473-9959
Is Sole Proprietor?:No
Enumeration Date:2011-07-21
Last Update Date:2015-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35123470208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0105593Medicaid