Provider Demographics
NPI:1356340269
Name:SHARP, KENNETH R (DO)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:R
Last Name:SHARP
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 783311
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-3311
Mailing Address - Country:US
Mailing Address - Phone:484-884-4500
Mailing Address - Fax:484-884-0699
Practice Address - Street 1:363 N 1ST ST
Practice Address - Street 2:
Practice Address - City:LEHIGHTON
Practice Address - State:PA
Practice Address - Zip Code:18235-1450
Practice Address - Country:US
Practice Address - Phone:484-464-9510
Practice Address - Fax:484-464-9515
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-21
Last Update Date:2018-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS010664L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA00000015397OtherTHREE RIVERS/MEDPLUS IND.
PA002653OtherFIRST PRIORITY INDIV.NUM.
PA001847462Medicaid
PA02292600OtherCAPITAL BLUE SHIELD GROUP
PACE2338OtherRAILROAD MEDICARE GRP.NUM
PAP3303851OtherOXFORD HEALTH PLAN
PA020286200OtherFEDERAL BLACK LUNG
PA50036350OtherCAPITAL BLUE CROSS INDIV.
PAP00106254OtherRAILROAD MEDICARE INDIV.
PA000000131265OtherTHREE RIVERS/MEDPLUS GRP.
PACA869935OtherBLUE SHIELD GROUP NUMBER
PASH1300891OtherBLUE SHIELD IND. ID NUM
PAH39810Medicare UPIN
PA001847462Medicaid
PACE2338OtherRAILROAD MEDICARE GRP.NUM