Basic Information
| Provider Information | |||||||||
| NPI: | 1033516414 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SHARON PALUSHOCK, M.D., P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 LAFLIN RD | ||||||||
| Address2: | |||||||||
| City: | WILKES BARRE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 187027238 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5708850963 | ||||||||
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| Practice Location | |||||||||
| Address1: | 939 MOOSIC RD | ||||||||
| Address2: | |||||||||
| City: | OLD FORGE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 185182034 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5704713506 | ||||||||
| FaxNumber: | 5704713507 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/01/2014 | ||||||||
| LastUpdateDate: | 12/01/2014 | ||||||||
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| AuthorizedOfficialLastName: | PALUSHOCK | ||||||||
| AuthorizedOfficialFirstName: | SHARON | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 5708850963 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RE0101X | MD040639 L | PA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism |
ID Information
| ID | Type | State | Issuer | Description | 001261360 | 05 | PA | MEDICAID |