Healthcare Provider Details

I. General information

NPI: 1356304315
Provider Name (Legal Business Name): SHARON A. BOLSAR PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2006
Last Update Date: 07/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 COMMUNITY DR MOUNTAIN FAMILY CARE. SUITE 102
TOBYHANNA PA
18466-8985
US

IV. Provider business mailing address

206 E BROWN ST POCONO HEALTHCARE MGMT. - PROFESSIONAL BLDG.
EAST STROUDSBURG PA
18301-3006
US

V. Phone/Fax

Practice location:
  • Phone: 570-895-2300
  • Fax: 570-895-4270
Mailing address:
  • Phone: 570-420-4997
  • Fax: 570-476-3754

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberMA003362L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: