1538478029 NPI number — SHARON FOSTER GARDEPE, M.D., P.C.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538478029 NPI number — SHARON FOSTER GARDEPE, M.D., P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SHARON FOSTER GARDEPE, M.D., P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1538478029
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/27/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
201 SIVLEY RD SW
Provider Second Line Business Mailing Address:
SUITE 510
Provider Business Mailing Address City Name:
HUNTSVILLE
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35801-5138
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
256-536-0992
Provider Business Mailing Address Fax Number:
256-265-2765

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
201 SIVLEY RD SW
Provider Second Line Business Practice Location Address:
SUITE 510
Provider Business Practice Location Address City Name:
HUNTSVILLE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35801-5134
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
256-536-0992
Provider Business Practice Location Address Fax Number:
256-265-2765
Provider Enumeration Date:
09/30/2010

Additional Information

Authorized Official

Authorized Official Last Name:
GARDEPE
Authorized Official First Name:
SHARON
Authorized Official Middle Name:
FOSTER
Authorized Official Title or Position:
OWNER/PHYSICIAN
Authorized Official Telephone Number:
256-536-0992

Provider Taxonomy Codes

  • Taxonomy code: 207N00000X , with the licence number:  4558 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000013501 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0004003541 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 51013501 . This is a "BLUECROSS AND BLUESHIELD" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




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