Provider Demographics
NPI:1104810126
Name:SHARKEY, MARTHA ANN B (MD)
Entity type:Individual
Prefix:DR
First Name:MARTHA ANN
Middle Name:B
Last Name:SHARKEY
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 1:3360 E CARMEL LN
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72701-2834
Mailing Address - Country:US
Mailing Address - Phone:479-582-0719
Mailing Address - Fax:479-464-8231
Practice Address - Street 1:5507 WALSH LN
Practice Address - Street 2:SUITE 101
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72758-8941
Practice Address - Country:US
Practice Address - Phone:479-464-8231
Practice Address - Fax:479-464-8230
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-06
Last Update Date:2011-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE2002208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR135776001Medicaid
ARG87228Medicare UPIN
AR135776001Medicaid