Provider Demographics
NPI:1043579527
Name:SHARMA, MARUTI (MD)
Entity Type:Individual
Prefix:
First Name:MARUTI
Middle Name:
Last Name:SHARMA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 STEVENS AVE STE 208
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:10550-2682
Mailing Address - Country:US
Mailing Address - Phone:914-699-7645
Mailing Address - Fax:914-699-8092
Practice Address - Street 1:105 STEVENS AVE STE 208
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:NY
Practice Address - Zip Code:10550
Practice Address - Country:US
Practice Address - Phone:914-699-7645
Practice Address - Fax:914-699-8092
Is Sole Proprietor?:No
Enumeration Date:2012-05-03
Last Update Date:2019-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY287164207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY05244959Medicaid