Basic Information
Provider Information
NPI: 1912285065
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: EPSTEIN
FirstName: SHARA
MiddleName: ILYSE
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1601 CHERRY ST
Address2: SUITE 11511
City: PHILADELPHIA
State: PA
PostalCode: 191021320
CountryCode: US
TelephoneNumber: 2152557822
FaxNumber: 2152557825
Practice Location
Address1: 1427 VINE ST
Address2: 2ND FLOOR
City: PHILADELPHIA
State: PA
PostalCode: 191021031
CountryCode: US
TelephoneNumber: 2157622530
FaxNumber: 2157622531
Other Information
ProviderEnumerationDate: 07/22/2011
LastUpdateDate: 09/12/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RI0200XMD457001PAY Allopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
207R00000XMD457001PAN Allopathic & Osteopathic PhysiciansInternal Medicine 

No ID Information.


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