Provider Demographics
NPI:1437202116
Name:SHARETTS, SCOTT ROBERT (MD)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:ROBERT
Last Name:SHARETTS
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 1:301 LIPPINCOTT DR STE 410
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-4197
Mailing Address - Country:US
Mailing Address - Phone:856-355-0340
Mailing Address - Fax:856-355-0330
Practice Address - Street 1:101 BURRS RD STE C
Practice Address - Street 2:
Practice Address - City:WESTAMPTON
Practice Address - State:NJ
Practice Address - Zip Code:08060-5517
Practice Address - Country:US
Practice Address - Phone:609-871-7500
Practice Address - Fax:609-444-5657
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2024-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA042425002084N0400X, 2085D0003X
PAMD030059E2084N0400X, 2085D0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2085D0003XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Neuroimaging
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2462303Medicaid
A54788Medicare UPIN
0058994OtherGHI
14905OtherUNIVERSITY HEALTH PLAN
NJ2462303Medicaid
0082213000OtherAMERIHEALTH
NJ000130057OtherPA BLUE SHIELD
80552OtherAMERIGROUP
0030222OtherAETNA HMO
F05771OtherHEALTH NET
1295287002OtherCIGNA
A54788Medicare UPIN
0082213000OtherKEYSTONE HPE
NJ1039964OtherHORIZON NJ HEALTH
NJBU00010800OtherAMERICHOICE
363582900OtherUS DEPT OF LABOR W
4090808OtherAETNA MANAGED CARE PPO