Provider Demographics
NPI:1730521568
Name:SHARPCARE MEDICAL GROUP, APC
Entity type:Organization
Organization Name:SHARPCARE MEDICAL GROUP, APC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:ROTH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:858-541-0181
Mailing Address - Street 1:8695 SPECTRUM CENTER BLVD.
Mailing Address - Street 2:ATTN: NETWORK MANAGEMENT - 4TH FLOOR
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123
Mailing Address - Country:US
Mailing Address - Phone:858-499-4510
Mailing Address - Fax:858-636-2243
Practice Address - Street 1:230 PROSPECT PLACE
Practice Address - Street 2:SUITE 340-B
Practice Address - City:CORONADO
Practice Address - State:CA
Practice Address - Zip Code:92118
Practice Address - Country:US
Practice Address - Phone:619-522-4000
Practice Address - Fax:619-435-0150
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-22
Last Update Date:2016-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty