| Name: | Sharon Foster Gardepe, M.D., P.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Corporation |
| Status: | Exists |
| Date of registration: | 31 Oct 1985 (39 years ago) |
| Entity Number: | 000-106-855 |
| Register Number: | 000106855 |
| County: | Madison |
| Place of Formation: | Madison County |
| Principal Address: | HUNTSVILLE, AL |
| Registered Office Street Address: | 2006 FRANKLIN ST SUITE 204HUNTSVILLE, AL 35801 |
| Registered Office Street Address ZIP Code: | 35801 |
| Authorized Capital: | $2,000 |
Activities
DERMATOLOGY
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1538478029 | 2010-09-30 | 2015-04-27 | 201 SIVLEY RD SW, SUITE 510, HUNTSVILLE, AL, 358015138, US | 201 SIVLEY RD SW, SUITE 510, HUNTSVILLE, AL, 358015134, US | |||||||||||||||||||||||||||||||||||
|
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| Phone | +1 256-536-0992 |
| Fax | 2562652765 |
Authorized person
| Name | SHARON FOSTER GARDEPE |
| Role | OWNER/PHYSICIAN |
| Phone | 2565360992 |
Taxonomy
| Taxonomy Code | 207N00000X - Dermatology Physician |
| License Number | 4558 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 000013501 |
| State | AL |
| Issuer | AETNA |
| Number | 0004003541 |
| Issuer | BLUECROSS AND BLUESHIELD |
| Number | 51013501 |
| State | AL |
| Name | Role |
|---|---|
| GARDEPE, SHARON FOSTER MD | Agent |
| Name | Role |
|---|---|
| GARDEPE, SHARON FOSTER MD | Incorporator |
Date of last update: 31 Jul 2024
Sources: Alabama Secretary of State
