Healthcare Provider Details

I. General information

NPI: 1154307403
Provider Name (Legal Business Name): SHARON M CAMPION MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2005
Last Update Date: 01/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 PLANTATION ST
WORCESTER MA
01605-2038
US

IV. Provider business mailing address

630 PLANTATION ST
WORCESTER MA
01605-2038
US

V. Phone/Fax

Practice location:
  • Phone: 508-856-0590
  • Fax: 580-852-1022
Mailing address:
  • Phone: 508-856-0590
  • Fax: 508-852-1022

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number74058
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: