Provider Demographics
NPI:1801904958
Name:GIBSON, SHARON E (MD)
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:E
Last Name:GIBSON
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 1:118 DUDLEY ST
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02905-2403
Mailing Address - Country:US
Mailing Address - Phone:401-274-2300
Mailing Address - Fax:401-272-1302
Practice Address - Street 1:130 WATERMAN ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02906-2010
Practice Address - Country:US
Practice Address - Phone:401-274-2300
Practice Address - Fax:401-272-1302
Is Sole Proprietor?:No
Enumeration Date:2006-08-28
Last Update Date:2014-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD09174207YP0228X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YP0228XAllopathic & Osteopathic PhysiciansOtolaryngologyPediatric Otolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI9020307Medicaid
RI9020307Medicaid
RI49020307Medicare ID - Type Unspecified