Provider Demographics
NPI:1770834509
Name:DUCKER, SHARON LOUISE (NCSMT&KTP)
Entity Type:Individual
Prefix:MS
First Name:SHARON
Middle Name:LOUISE
Last Name:DUCKER
Suffix:
Gender:F
Credentials:NCSMT&KTP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:224 MAIN ST STE 1C
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:NH
Mailing Address - Zip Code:03079-3174
Mailing Address - Country:US
Mailing Address - Phone:617-281-2811
Mailing Address - Fax:
Practice Address - Street 1:224 MAIN ST STE 1C
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:NH
Practice Address - Zip Code:03079-3174
Practice Address - Country:US
Practice Address - Phone:617-281-2811
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-19
Last Update Date:2013-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3328 MA204C00000X
NH3980204C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports Medicine