Provider Demographics
NPI:1134120173
Name:SHARP, JOHN C
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:C
Last Name:SHARP
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 320
Mailing Address - Street 2:
Mailing Address - City:MARLINTON
Mailing Address - State:WV
Mailing Address - Zip Code:24954-0320
Mailing Address - Country:US
Mailing Address - Phone:304-799-4645
Mailing Address - Fax:304-799-7314
Practice Address - Street 1:105 DUNCAN RD
Practice Address - Street 2:
Practice Address - City:MARLINTON
Practice Address - State:WV
Practice Address - Zip Code:24954-0320
Practice Address - Country:US
Practice Address - Phone:304-799-4645
Practice Address - Fax:304-799-7314
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV806204C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0049786000Medicaid
WV0049786001Medicaid
WVE05947Medicare UPIN
WVSH0515594Medicare ID - Type UnspecifiedGREEN BANK OFFICE
WV0049786001Medicaid