Basic Information
| Provider Information | |||||||||
| NPI: | 1154307403 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CAMPION | ||||||||
| FirstName: | SHARON | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 630 PLANTATION ST | ||||||||
| Address2: | |||||||||
| City: | WORCESTER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 016052038 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5088560590 | ||||||||
| FaxNumber: | 5088521022 | ||||||||
| Practice Location | |||||||||
| Address1: | 630 PLANTATION ST | ||||||||
| Address2: | |||||||||
| City: | WORCESTER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 016052038 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5088560590 | ||||||||
| FaxNumber: | 5808521022 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/19/2005 | ||||||||
| LastUpdateDate: | 01/28/2009 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 74058 | MA | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | J30379 | 01 | MEDICARE B | OTHER | 2039821 | 01 | FIRST HEALTH | OTHER | 9901021 | 01 | FALLON COMMUNITY HELATH P | OTHER | J30379 | 01 | BLUE SHIELD HMO BLUE | OTHER | 042472266 | 01 | PRIVATE HEALTHCARE SYSTEM | OTHER | 042472266 | 01 | THREE RIVERS | OTHER | 26783 | 01 | CHILDRENS MEDICAL SECURIT | OTHER | 457053 | 01 | TUFTS HEALTH PLAN | OTHER | 784118 | 01 | MVP HEALTH CARE | OTHER | 3104605 | 01 | MEDICAID/WELFARE | OTHER | J30379 | 01 | BLUE SHIELD INDEMNITY | OTHER | 3104605 | 05 | MA | MEDICAID | AA1168 | 01 | HARVARD PILGRIM HEALTHCAR | OTHER | 0011288 | 01 | CIGNA HEALTH PLAN | OTHER | 042472266 | 01 | ONE HEALTH PLAN | OTHER | 7617400 | 01 | AETNA/US HEALTHCARE | OTHER | 26783 | 01 | HEALTHY START | OTHER | J30379 | 01 | BLUE CARE ELECT | OTHER |