Provider Demographics
NPI:1780639773
Name:SHARBAUGH, CHARLES RICHARD (DO)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:RICHARD
Last Name:SHARBAUGH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3800 LIMESTONE RD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19808-2075
Mailing Address - Country:US
Mailing Address - Phone:302-998-2219
Mailing Address - Fax:302-633-6938
Practice Address - Street 1:3800 LIMESTONE RD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19808-2075
Practice Address - Country:US
Practice Address - Phone:302-998-2219
Practice Address - Fax:302-633-6938
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2014-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC20001718207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE000060203Medicaid
000410368Medicare ID - Type Unspecified
DE000060203Medicaid