Provider Demographics
NPI:1851350508
Name:SHARE, JEROLD M (MD)
Entity Type:Individual
Prefix:DR
First Name:JEROLD
Middle Name:M
Last Name:SHARE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:PO BOX 1400
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22038-1400
Mailing Address - Country:US
Mailing Address - Phone:703-383-9543
Mailing Address - Fax:703-383-9532
Practice Address - Street 1:3301 NEW MEXICO AVE NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20016-3612
Practice Address - Country:US
Practice Address - Phone:202-244-0060
Practice Address - Fax:202-362-6907
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-21
Last Update Date:2018-12-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
DCMD21208207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
460002434OtherRR MEDICARE
DC026973300Medicaid