Provider Demographics
NPI:1144249467
Name:MIRARCHI, SHARON RENEE (MD)
Entity type:Individual
Prefix:DR
First Name:SHARON
Middle Name:RENEE
Last Name:MIRARCHI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:SHARON
Other - Middle Name:RENEE
Other - Last Name:RANSOM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10180 SE SUNNYSIDE ROAD
Mailing Address - Street 2:KAISER SUNNYSIDE MEDICAL CENTER
Mailing Address - City:CLACKAMAS
Mailing Address - State:OR
Mailing Address - Zip Code:97015
Mailing Address - Country:US
Mailing Address - Phone:503-652-2880
Mailing Address - Fax:310-388-3029
Practice Address - Street 1:10180 SE SUNNYSIDE ROAD
Practice Address - Street 2:KAISER SUNNYSIDE MEDICAL CENTER
Practice Address - City:CLACKAMAS
Practice Address - State:OR
Practice Address - Zip Code:97015
Practice Address - Country:US
Practice Address - Phone:503-652-2880
Practice Address - Fax:310-388-3029
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2008-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35085750174400000X
PAMD4286482085R0202X
ORMD284262085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHMI422032OtherMEDICARE PTAN
PA1020379600001Medicaid
OHMI422032OtherMEDICARE PTAN
OH4220031Medicare PIN