Provider Demographics
NPI:1003144288
Name:DEEPAK SHARMA
Entity Type:Organization
Organization Name:DEEPAK SHARMA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTY
Authorized Official - Middle Name:M
Authorized Official - Last Name:BOARDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-893-4183
Mailing Address - Street 1:23 STILES RD
Mailing Address - Street 2:STE. 219
Mailing Address - City:SALEM
Mailing Address - State:NH
Mailing Address - Zip Code:03079-2859
Mailing Address - Country:US
Mailing Address - Phone:603-893-8030
Mailing Address - Fax:603-890-3713
Practice Address - Street 1:23 STILES RD
Practice Address - Street 2:STE. 219
Practice Address - City:SALEM
Practice Address - State:NH
Practice Address - Zip Code:03079-2859
Practice Address - Country:US
Practice Address - Phone:603-893-8030
Practice Address - Fax:603-890-3713
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-25
Last Update Date:2009-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2792133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty