Healthcare Provider Details

I. General information

NPI: 1851350508
Provider Name (Legal Business Name): JEROLD M SHARE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2006
Last Update Date: 12/31/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3301 NEW MEXICO AVE NW
WASHINGTON DC
20016-3612
US

IV. Provider business mailing address

PO BOX 1400
FAIRFAX VA
22038-1400
US

V. Phone/Fax

Practice location:
  • Phone: 202-244-0060
  • Fax: 202-362-6907
Mailing address:
  • Phone: 703-383-9543
  • Fax: 703-383-9532

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberMD21208
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: