Basic Information
| Provider Information | |||||||||
| NPI: | 1154300036 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PALUSHOCK | ||||||||
| FirstName: | SHARON | ||||||||
| MiddleName: | |||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 939 MOOSIC RD | ||||||||
| Address2: | |||||||||
| City: | OLD FORGE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 185182034 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5704713506 | ||||||||
| FaxNumber: | 5704713407 | ||||||||
| Practice Location | |||||||||
| Address1: | 939 MOOSIC RD | ||||||||
| Address2: | |||||||||
| City: | OLD FORGE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 185182034 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5704713506 | ||||||||
| FaxNumber: | 5704713407 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/10/2006 | ||||||||
| LastUpdateDate: | 01/16/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | MD040639 L | PA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RE0101X | MD040639 L | PA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism |
ID Information
| ID | Type | State | Issuer | Description | 001261360 | 05 | PA | MEDICAID |