Provider Demographics
NPI:1083671325
Name:ZIEGLER, SHARON L (MD)
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:L
Last Name:ZIEGLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 W STATE ST
Mailing Address - Street 2:ATTN: BOB BLOOM
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-5429
Mailing Address - Country:US
Mailing Address - Phone:607-277-4341
Mailing Address - Fax:607-216-0902
Practice Address - Street 1:209 W STATE ST
Practice Address - Street 2:ATTN: BOB BLOOM
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-5429
Practice Address - Country:US
Practice Address - Phone:607-277-4341
Practice Address - Fax:607-216-0902
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2014-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY187809207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY159949BFOtherPREFERRED CARE LEGACY#
NY187809-9OtherWORKERS COMP LEGACY#
NYP00357165OtherMEDICARE RAILROAD LEGACY#
NY000523202007OtherHEALTH NOW BCBS LEGACY#
NY8494418Medicaid
NY00010194103OtherUNIVERA LEGACY#
NY0106061OtherIHA LEGACY#
NY040426035684OtherFIDELIS LEGACY#
NY187809-9OtherWORKERS COMP LEGACY#
NYDD6753Medicare ID - Type Unspecified