Provider Demographics
NPI:1881656957
Name:DEWIT, SHARON ANN (MD)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:ANN
Last Name:DEWIT
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 1:1860 MOWRY AVE
Mailing Address - Street 2:STE 200
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-1730
Mailing Address - Country:US
Mailing Address - Phone:510-790-2202
Mailing Address - Fax:510-790-2806
Practice Address - Street 1:1860 MOWRY AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-1730
Practice Address - Country:US
Practice Address - Phone:510-409-2751
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-04
Last Update Date:2018-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG18768207ZC0500X, 207ZP0102X, 207U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207U00000XAllopathic & Osteopathic PhysiciansNuclear Medicine
No207ZC0500XAllopathic & Osteopathic PhysiciansPathologyCytopathology
No207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C170000Medicaid
CAA40416Medicare UPIN
CA00C177000Medicare ID - Type UnspecifiedPPIN