Provider Demographics
NPI:1770779712
Name:SIEBOLD, SHARON T (DPM)
Entity type:Individual
Prefix:DR
First Name:SHARON
Middle Name:T
Last Name:SIEBOLD
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1838 GREENE TREE RD
Mailing Address - Street 2:#430
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-6391
Mailing Address - Country:US
Mailing Address - Phone:410-602-8637
Mailing Address - Fax:410-795-2154
Practice Address - Street 1:1838 GREENE TREE RD
Practice Address - Street 2:#430
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21208-6391
Practice Address - Country:US
Practice Address - Phone:410-602-8637
Practice Address - Fax:410-795-2154
Is Sole Proprietor?:No
Enumeration Date:2007-09-24
Last Update Date:2011-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01290213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD7470188OtherAETNA PPO
MD480032060OtherMEDICARE RAILROAD
MD8255005OtherBLUE CHOICE
MD133210400Medicaid
1793270OtherAETNA HMO
MD60558606OtherBLUE CROSS BLUESHIELD
MD8255005OtherBLUE CHOICE
MD133210400Medicaid