Healthcare Provider Details

I. General information

NPI: 1881003978
Provider Name (Legal Business Name): SHAROON QAISER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2014
Last Update Date: 05/02/2022
Certification Date: 05/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 ROSE ST MN472
LEXINGTON KY
40536-0001
US

IV. Provider business mailing address

2141 SHAKER RUN RD
LEXINGTON KY
40509-8471
US

V. Phone/Fax

Practice location:
  • Phone: 859-323-5157
  • Fax: 859-323-1315
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberR3595
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License Number52704
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: