Provider Demographics
NPI:1770779712
Name:SIEBOLD, SHARON T (DPM)
Entity type:Individual
Prefix:DR
First Name:SHARON
Middle Name:T
Last Name:SIEBOLD
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:199 NEW RD STE 47
Mailing Address - Street 2:
Mailing Address - City:LINWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08221-2025
Mailing Address - Country:US
Mailing Address - Phone:609-904-0900
Mailing Address - Fax:
Practice Address - Street 1:199 NEW RD STE 47
Practice Address - Street 2:
Practice Address - City:LINWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08221-2025
Practice Address - Country:US
Practice Address - Phone:609-904-0900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-24
Last Update Date:2025-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00384200213ES0131X, 213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1063383Medicaid
MD60558606OtherBLUE CROSS BLUESHIELD
1793270OtherAETNA HMO
MD8255005OtherBLUE CHOICE
MD133210400Medicaid
MD480032060OtherMEDICARE RAILROAD
MD8255005OtherBLUE CHOICE
MD133210400Medicaid