Provider Demographics
NPI:1700826609
Name:FINE, SHARON R (MD)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:R
Last Name:FINE
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 1:139 E WYNNEWOOD RD
Mailing Address - Street 2:
Mailing Address - City:MERION STATION
Mailing Address - State:PA
Mailing Address - Zip Code:19066-1626
Mailing Address - Country:US
Mailing Address - Phone:610-667-0716
Mailing Address - Fax:
Practice Address - Street 1:501 N LANSDOWNE AVE
Practice Address - Street 2:DCMH
Practice Address - City:DREXEL HILL
Practice Address - State:PA
Practice Address - Zip Code:19026-1114
Practice Address - Country:US
Practice Address - Phone:610-394-1735
Practice Address - Fax:610-284-8312
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2013-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD070040L2085B0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody Imaging
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001956725Medicaid
PA001956725Medicaid
069765Medicare PIN
PAH84020Medicare UPIN