Provider Demographics
NPI:1891884375
Name:MARTIN, SHARON EUNICE (MD PHD)
Entity Type:Individual
Prefix:DR
First Name:SHARON
Middle Name:EUNICE
Last Name:MARTIN
Suffix:
Gender:F
Credentials:MD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4133 MEDICAL CENTER DR
Mailing Address - Street 2:
Mailing Address - City:BROAD TOP
Mailing Address - State:PA
Mailing Address - Zip Code:16621-9001
Mailing Address - Country:US
Mailing Address - Phone:814-635-2916
Mailing Address - Fax:814-635-2918
Practice Address - Street 1:626 WATER ST
Practice Address - Street 2:
Practice Address - City:ORBISONIA
Practice Address - State:PA
Practice Address - Zip Code:17243-9432
Practice Address - Country:US
Practice Address - Phone:814-447-3159
Practice Address - Fax:814-447-3195
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD067389L207R00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA50002184OtherCAPITAL BLUE CROSS
PA560054OtherHIGHMARK BLUE SHIELD
PA0017504800005Medicaid
PA050473Medicare ID - Type Unspecified
PA0017504800005Medicaid