Provider Demographics
NPI:1215941711
Name:SHARP, TRACY LYNN (DO)
Entity type:Individual
Prefix:MS
First Name:TRACY
Middle Name:LYNN
Last Name:SHARP
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2875 W ELM ST
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45805
Mailing Address - Country:US
Mailing Address - Phone:419-991-7805
Mailing Address - Fax:419-991-7862
Practice Address - Street 1:1100 DEFIANCE ST
Practice Address - Street 2:
Practice Address - City:WAPAKONETA
Practice Address - State:OH
Practice Address - Zip Code:45895-1022
Practice Address - Country:US
Practice Address - Phone:419-996-5122
Practice Address - Fax:419-996-5123
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34008386207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2653696Medicaid
OH9934001OtherMEDICARE PTAN
OH000000488903OtherANTHEM PROVIDER #
OHP00364353OtherRAIL ROAD MEDICARE
1134112469OtherGROUP NPI# PRIMARY OFFICE
1669550182OtherGROUP NPI# SATELLITE OFFI
OH000000488903OtherANTHEM PROVIDER #
OHP00364353OtherRAIL ROAD MEDICARE