Healthcare Provider Details

I. General information

NPI: 1114168028
Provider Name (Legal Business Name): SHARON E BRIDGEMAN-SHAH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2009
Last Update Date: 03/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HOWARD UNIVERSITY HOSPITAL 2041 GEORGIA AVENUE N.W. STE 2107
WASHINGTON DC
20060-0001
US

IV. Provider business mailing address

HOWARD UNIVERSITY HOSPITAL 2041 GEORGIA AVENUE N.W. STE 2107
WASHINGTON DC
20060-0001
US

V. Phone/Fax

Practice location:
  • Phone: 202-865-6725
  • Fax: 202-865-1757
Mailing address:
  • Phone: 202-865-6725
  • Fax: 202-865-1757

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberMD21597
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: