Provider Demographics
NPI:1639369887
Name:BEN-OR, SHARON (MD)
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:
Last Name:BEN-OR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 E SAMPLE RD STE 101
Mailing Address - Street 2:
Mailing Address - City:LIGHTHOUSE POINT
Mailing Address - State:FL
Mailing Address - Zip Code:33064-7574
Mailing Address - Country:US
Mailing Address - Phone:954-958-7195
Mailing Address - Fax:954-958-7115
Practice Address - Street 1:1 W SAMPLE RD STE 207
Practice Address - Street 2:
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33064-3547
Practice Address - Country:US
Practice Address - Phone:954-958-7195
Practice Address - Fax:954-958-7115
Is Sole Proprietor?:No
Enumeration Date:2007-07-25
Last Update Date:2024-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME162112208G00000X
NC2009-01805208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC159A1OtherBCBSNC
NC5915573Medicaid
NC5915573Medicaid