Provider Demographics
NPI:1710013628
Name:CARSWELL, SHARON E (MD)
Entity type:Individual
Prefix:DR
First Name:SHARON
Middle Name:E
Last Name:CARSWELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:211 E LOGAN ST
Mailing Address - Street 2:SUITE 303
Mailing Address - City:CALDWELL
Mailing Address - State:ID
Mailing Address - Zip Code:83605-4882
Mailing Address - Country:US
Mailing Address - Phone:208-459-4667
Mailing Address - Fax:208-459-3372
Practice Address - Street 1:211 E LOGAN ST
Practice Address - Street 2:SUITE 303
Practice Address - City:CALDWELL
Practice Address - State:ID
Practice Address - Zip Code:83605-4882
Practice Address - Country:US
Practice Address - Phone:208-459-4667
Practice Address - Fax:208-459-3372
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2009-07-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IDM9681207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID807192600Medicaid
ID1196007Medicare PIN
ID807192600Medicaid