Provider Demographics
NPI:1821217787
Name:WERTHAMMER, SHARON LAO (MD)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:LAO
Last Name:WERTHAMMER
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 1:1451 HARRODSBURG RD STE D302
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40504-3772
Mailing Address - Country:US
Mailing Address - Phone:859-260-1273
Mailing Address - Fax:859-260-7719
Practice Address - Street 1:1451 HARRODSBURG RD STE D302
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40504-3772
Practice Address - Country:US
Practice Address - Phone:859-260-1273
Practice Address - Fax:859-260-7719
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2009-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY40928174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1649475492OtherORGANIZATIONAL NPI
KY2084N0400XOtherTAXONOMY
KY7100023560Medicaid
KY2084N0400XOtherTAXONOMY