Provider Demographics
NPI:1336188044
Name:SHARP, MARY P (MD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:P
Last Name:SHARP
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1703 E MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48912-2841
Mailing Address - Country:US
Mailing Address - Phone:517-913-3860
Mailing Address - Fax:517-484-6864
Practice Address - Street 1:1703 E MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48912-2841
Practice Address - Country:US
Practice Address - Phone:517-913-3860
Practice Address - Fax:517-484-6864
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2009-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301044837207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI200000002706OtherPHP FAMILYCARE
MI1009478OtherMCLAREN HEALTH PLAN-MEDICAID
MI110245480OtherRAILROAD MEDICARE
MI4437261Medicaid
MI4482115OtherAETNA
MI1009478OtherMCLAREN HEALTH ADVANTAGE
MI1009478OtherMCLAREN HEALTH PLAN-COMMERCIAL
MI0803310911OtherBCBS/BCN
MI0M54770005OtherMEDICARE ADVANTAGE
MI200000002706OtherPHP
MI1009478OtherMCLAREN HEALTH PLAN-COMMERCIAL
MI200000002706OtherPHP FAMILYCARE