Provider Demographics
NPI:1811107683
Name:WAGAMON, SHARON SANBORN (MD)
Entity type:Individual
Prefix:DR
First Name:SHARON
Middle Name:SANBORN
Last Name:WAGAMON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SHARON
Other - Middle Name:LYNN
Other - Last Name:SANBORN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:19151 NELSON PARKMAN RD
Mailing Address - Street 2:
Mailing Address - City:GARRETTSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44231-9559
Mailing Address - Country:US
Mailing Address - Phone:440-468-9239
Mailing Address - Fax:
Practice Address - Street 1:870 W MAIN ST
Practice Address - Street 2:
Practice Address - City:GENEVA
Practice Address - State:OH
Practice Address - Zip Code:44041-1219
Practice Address - Country:US
Practice Address - Phone:440-415-0158
Practice Address - Fax:216-201-8172
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2020-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH57.010919207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2838317Medicaid