Basic Information
| Provider Information | |||||||||
| NPI: | 1356397608 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SAX | ||||||||
| FirstName: | SHARON | ||||||||
| MiddleName: | A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5525 MARIE AVE | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452483230 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5139815463 | ||||||||
| FaxNumber: | 5135982242 | ||||||||
| Practice Location | |||||||||
| Address1: | 5525 MARIE AVE | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452483230 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5139815463 | ||||||||
| FaxNumber: | 5135982242 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/26/2006 | ||||||||
| LastUpdateDate: | 08/01/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 35058462 | OH | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | P00919623 | 01 | OH | MEDICARE RR | OTHER | 0165584 | 05 | OH | MEDICAID |