MEDICARE: KENNETH R SHARP DO

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
1	207Q00000X	Family Medicine Physician	OS010664L	PA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
5	CE2338	OTHER	PA	RAILROAD MEDICARE GRP.NUM
9	P00106254	OTHER	PA	RAILROAD MEDICARE INDIV.

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00000015397	OTHER	PA	THREE RIVERS/MEDPLUS IND.
2	002653	OTHER	PA	FIRST PRIORITY INDIV.NUM.
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	02292600	OTHER	PA	CAPITAL BLUE SHIELD GROUP
6	P3303851	OTHER	PA	OXFORD HEALTH PLAN
7	020286200	OTHER	PA	FEDERAL BLACK LUNG
8	50036350	OTHER	PA	CAPITAL BLUE CROSS INDIV.
10	000000131265	OTHER	PA	THREE RIVERS/MEDPLUS GRP.
11	CA869935	OTHER	PA	BLUE SHIELD GROUP NUMBER
12	SH1300891	OTHER	PA	BLUE SHIELD IND. ID NUM

General Provider Information

NPI Number	:	1356340269
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENNETH R SHARP DO

Provider Business Mailing Address
First Line	:	PO BOX 783311
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19178-3311
Country	:	US
Telephone Number	:	484-884-4500
Fax Number	:	484-884-0699

Provider Business Practice Location Address
First Line	:	363 N 1ST ST
Second Line	:
City	:	LEHIGHTON
State	:	PA
Zip	:	18235-1450
Country	:	US
Telephone Number	:	484-464-9510
Fax Number	:	484-464-9515

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/21/2005
Last Update Date	:	09/24/2018

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Directions to “ KENNETH R SHARP DO” Practice Location

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