Provider Demographics
NPI:1770697021
Name:AHART, SHARON L (MD)
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:L
Last Name:AHART
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 1:815 S AUBURN ST
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-5661
Mailing Address - Country:US
Mailing Address - Phone:509-586-5109
Mailing Address - Fax:509-586-5174
Practice Address - Street 1:815 S AUBURN ST
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-5661
Practice Address - Country:US
Practice Address - Phone:509-586-5109
Practice Address - Fax:509-586-5174
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00032191208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAF19516Medicare UPIN