Healthcare Provider Details

I. General information

NPI: 1720053853
Provider Name (Legal Business Name): JOAN G SHARLOW RPAC
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43 NEW SCOTLAND AVE MC157 THE VASCULAR GROUP PLLC
ALBANY NY
12208
US

IV. Provider business mailing address

43 NEW SCOTLAND AVE MC157 THE VASCULAR GROUP PLLC
ALBANY NY
12208
US

V. Phone/Fax

Practice location:
  • Phone: 518-262-5640
  • Fax: 518-262-5110
Mailing address:
  • Phone: 518-262-5640
  • Fax: 518-262-5110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number003204
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: