Provider Demographics
NPI:1912932617
Name:SHARP, RHONDA L (MD)
Entity Type:Individual
Prefix:MRS
First Name:RHONDA
Middle Name:L
Last Name:SHARP
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 1:11109 PARKVIEW PLAZA DR # 117
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46845-1701
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2600 N DETROIT ST
Practice Address - Street 2:
Practice Address - City:LAGRANGE
Practice Address - State:IN
Practice Address - Zip Code:46761-1154
Practice Address - Country:US
Practice Address - Phone:260-463-4896
Practice Address - Fax:260-463-5242
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2022-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01047132207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200102520Medicaid
IN000000679273OtherANTHEM
ING30438Medicare UPIN
IN134810Medicare ID - Type Unspecified
INM400030033Medicare PIN