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NPI Code Detail

MEDICARE: DR. THEODORE M SHARPE PH.D.

MEDICARE: DR. THEODORE M SHARPE PH.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TC0700XClinical Psychologist20010197AIN

General Provider Information

NPI Number : 1104040765
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. THEODORE M SHARPE PH.D.
Provider Business Mailing Address
First Line : 6045 WATERSIDE DR
Second Line :
City : COLUMBUS
State : IN
Zip : 47201-3917
Country : US
Telephone Number : 812-376-6075
Fax Number :
Provider Business Practice Location Address
First Line : 2530 SANDCREST BLVD
Second Line :
City : COLUMBUS
State : IN
Zip : 47203-3047
Country : US
Telephone Number : 812-372-3177
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/12/2007
Last Update Date : 07/08/2007

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