Provider Demographics
NPI:1730347147
Name:FORD, SHARON LYNN (PA-C)
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:LYNN
Last Name:FORD
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:SHARON
Other - Middle Name:LYNN
Other - Last Name:WATTS-FORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:7401 OSLER DR
Mailing Address - Street 2:SUITE 205
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-7673
Mailing Address - Country:US
Mailing Address - Phone:410-828-8077
Mailing Address - Fax:410-828-8078
Practice Address - Street 1:7401 OSLER DR
Practice Address - Street 2:SUITE 205
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-7673
Practice Address - Country:US
Practice Address - Phone:410-828-8077
Practice Address - Fax:410-828-8078
Is Sole Proprietor?:No
Enumeration Date:2008-06-02
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0003743363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical