Provider Demographics
NPI:1063405736
Name:MCSHARRY, ROGER J (MD)
Entity type:Individual
Prefix:
First Name:ROGER
Middle Name:J
Last Name:MCSHARRY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 W STONE DR
Mailing Address - Street 2:SUITE 6A
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660-3365
Mailing Address - Country:US
Mailing Address - Phone:423-408-7220
Mailing Address - Fax:423-408-7405
Practice Address - Street 1:271 MEDICAL PARK BLVD
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:TN
Practice Address - Zip Code:37620-7455
Practice Address - Country:US
Practice Address - Phone:423-968-2311
Practice Address - Fax:423-968-2311
Is Sole Proprietor?:No
Enumeration Date:2005-08-26
Last Update Date:2014-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000028511207RP1001X
VA0101054883207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA290008725OtherPALMETTO RR MEDICARE
TN3804276Medicaid
VA290000173OtherTRAILBLAZERS MEDICARE
TN290008725OtherPALMETTO RR MEDICARE
VA290000173OtherTRAILBLAZERS MEDICARE
TN3804276Medicaid
VA018381W82Medicare PIN
TNG34743Medicare UPIN
VAV V5983AMedicare PIN
TN290008725OtherPALMETTO RR MEDICARE