Provider Demographics
NPI:1841375441
Name:JOHN C SHARP PHD.,D.O
Entity type:Organization
Organization Name:JOHN C SHARP PHD.,D.O
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:C
Authorized Official - Last Name:SHARP
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:304-799-4645
Mailing Address - Street 1:PO BOX 320
Mailing Address - Street 2:
Mailing Address - City:MARLINTON
Mailing Address - State:WV
Mailing Address - Zip Code:24954-0320
Mailing Address - Country:US
Mailing Address - Phone:304-799-4645
Mailing Address - Fax:304-799-7314
Practice Address - Street 1:105 DUNCAN ROAD
Practice Address - Street 2:
Practice Address - City:MARLINTON
Practice Address - State:WV
Practice Address - Zip Code:24954
Practice Address - Country:US
Practice Address - Phone:304-799-4645
Practice Address - Fax:304-799-7314
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV806207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810005777Medicaid
WV3810005777Medicaid
WVJO9318701Medicare ID - Type UnspecifiedGROUP NUMBER MARLINTON