Provider Demographics
NPI:1457342404
Name:DAWSO, SHARON R (MD)
Entity Type:Individual
Prefix:DR
First Name:SHARON
Middle Name:R
Last Name:DAWSO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1669 ROUTE 65
Mailing Address - Street 2:
Mailing Address - City:ELLWOOD CITY
Mailing Address - State:PA
Mailing Address - Zip Code:16117-5217
Mailing Address - Country:US
Mailing Address - Phone:724-773-8388
Mailing Address - Fax:
Practice Address - Street 1:1669 ROUTE 65
Practice Address - Street 2:
Practice Address - City:ELLWOOD CITY
Practice Address - State:PA
Practice Address - Zip Code:16117-5217
Practice Address - Country:US
Practice Address - Phone:724-773-8388
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2015-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD417520207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0019055660003Medicaid
OH2340078Medicaid
PA0019055660003Medicaid
PA064350Medicare PIN