Provider Demographics
NPI:1700028396
Name:BIALO, SHARA ROSE (MD)
Entity Type:Individual
Prefix:MS
First Name:SHARA
Middle Name:ROSE
Last Name:BIALO
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:PO BOX 191
Mailing Address - Street 2:PROVIDER ENROLLMENT
Mailing Address - City:ROCKLAND
Mailing Address - State:DE
Mailing Address - Zip Code:19732-0191
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:302-651-4945
Practice Address - Street 1:1280 ALMONESSON ROAD
Practice Address - Street 2:
Practice Address - City:DEPTFORD
Practice Address - State:NJ
Practice Address - Zip Code:08096-5502
Practice Address - Country:US
Practice Address - Phone:856-537-7060
Practice Address - Fax:856-805-9370
Is Sole Proprietor?:No
Enumeration Date:2009-03-30
Last Update Date:2017-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC1-00117232080P0205X
NJ25MA098808002080P0205X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0205XAllopathic & Osteopathic PhysiciansPediatricsPediatric Endocrinology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD7772050-00Medicaid
PA103170259Medicaid
PA103170259Medicaid