Provider Demographics
NPI:1649370933
Name:RISER, SHARON JUDITH (MD)
Entity type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:JUDITH
Last Name:RISER
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 1:2009 STONERIDGE LN
Mailing Address - Street 2:
Mailing Address - City:VILLANOVA
Mailing Address - State:PA
Mailing Address - Zip Code:19085-1723
Mailing Address - Country:US
Mailing Address - Phone:610-526-9482
Mailing Address - Fax:215-332-1873
Practice Address - Street 1:8001 ROOSEVELT BLVD
Practice Address - Street 2:205-207
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19152-3038
Practice Address - Country:US
Practice Address - Phone:215-332-1914
Practice Address - Fax:215-332-1873
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD031501E101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA139926OtherBC/BS ID
PA7375059OtherAETNA ID
PA0083209000OtherMAGELLAN ID
PA1091921Medicaid
PAB38990Medicare UPIN
PA1091921Medicaid