Provider Demographics
NPI:1396745816
Name:SHARON, MICHAEL R (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:R
Last Name:SHARON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 HARTFORD TPKE
Mailing Address - Street 2:
Mailing Address - City:VERNON
Mailing Address - State:CT
Mailing Address - Zip Code:06066-5042
Mailing Address - Country:US
Mailing Address - Phone:860-872-0888
Mailing Address - Fax:860-872-8940
Practice Address - Street 1:520 HARTFORD TPKE
Practice Address - Street 2:
Practice Address - City:VERNON
Practice Address - State:CT
Practice Address - Zip Code:06066-5042
Practice Address - Country:US
Practice Address - Phone:860-872-0888
Practice Address - Fax:860-872-8940
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-27
Last Update Date:2009-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT012493207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT710250OtherCONNECITCARE
CT010012493CT01OtherBC/BS
CT007879OtherAETNA
CT012493OtherCT STATE LISCENSE
CTP707361OtherOXFORD
CTPR01728790001OtherCIGNA
CT1124932Medicaid
CT1124932Medicaid
CTPR01728790001OtherCIGNA