Provider Demographics
NPI:1033516414
Name:SHARON PALUSHOCK, M.D., P.C.
Entity type:Organization
Organization Name:SHARON PALUSHOCK, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:
Authorized Official - Last Name:PALUSHOCK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:570-885-0963
Mailing Address - Street 1:100 LAFLIN RD
Mailing Address - Street 2:
Mailing Address - City:WILKES BARRE
Mailing Address - State:PA
Mailing Address - Zip Code:18702-7238
Mailing Address - Country:US
Mailing Address - Phone:570-885-0963
Mailing Address - Fax:
Practice Address - Street 1:939 MOOSIC RD
Practice Address - Street 2:
Practice Address - City:OLD FORGE
Practice Address - State:PA
Practice Address - Zip Code:18518-2034
Practice Address - Country:US
Practice Address - Phone:570-471-3506
Practice Address - Fax:570-471-3507
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-01
Last Update Date:2014-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD040639 L207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001261360Medicaid
F10502Medicare UPIN
PA001261360Medicaid