Provider Demographics
NPI:1841258092
Name:FORSMO, SHARON (PA)
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:
Last Name:FORSMO
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:298 ARMISTICE BLVD
Mailing Address - Street 2:
Mailing Address - City:PAWTUCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02861-2331
Mailing Address - Country:US
Mailing Address - Phone:508-473-1015
Mailing Address - Fax:508-634-0261
Practice Address - Street 1:236 MILFORD ST
Practice Address - Street 2:
Practice Address - City:UPTON
Practice Address - State:MA
Practice Address - Zip Code:01568
Practice Address - Country:US
Practice Address - Phone:508-473-1015
Practice Address - Fax:508-634-0261
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2019-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPA00149363AM0700X
MAPA4241207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI308313OtherBCBS
RI408244OtherBLUE CHIP
RI007008546Medicare ID - Type Unspecified
RI408244OtherBLUE CHIP
RI308313OtherBCBS