Provider Demographics
NPI:1952369175
Name:MACMILLAN, SHARON ANNE (MD)
Entity type:Individual
Prefix:DR
First Name:SHARON
Middle Name:ANNE
Last Name:MACMILLAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:200 SILVER STREET
Mailing Address - Street 2:SUITE 214
Mailing Address - City:AGAWAM
Mailing Address - State:MA
Mailing Address - Zip Code:01001
Mailing Address - Country:US
Mailing Address - Phone:413-209-9394
Mailing Address - Fax:413-209-8579
Practice Address - Street 1:200 SILVER STREET
Practice Address - Street 2:SUITE 214
Practice Address - City:AGAWAM
Practice Address - State:MA
Practice Address - Zip Code:01001
Practice Address - Country:US
Practice Address - Phone:413-209-9394
Practice Address - Fax:413-209-8579
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-04
Last Update Date:2012-09-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA204995207V00000X, 207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0124061Medicaid
MA0124061Medicaid
MAA32185Medicare ID - Type Unspecified