Provider Demographics
NPI:1083651780
Name:JAIN, SHARDA A (MD)
Entity Type:Individual
Prefix:
First Name:SHARDA
Middle Name:A
Last Name:JAIN
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 1:38 MOSTYN ST
Mailing Address - Street 2:
Mailing Address - City:SWAMPSCOTT
Mailing Address - State:MA
Mailing Address - Zip Code:01907-1617
Mailing Address - Country:US
Mailing Address - Phone:781-595-3366
Mailing Address - Fax:
Practice Address - Street 1:500 LYNNFIELD ST
Practice Address - Street 2:PULMONARY PHYSICIANS
Practice Address - City:LYNN
Practice Address - State:MA
Practice Address - Zip Code:01904-1424
Practice Address - Country:US
Practice Address - Phone:781-595-3366
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA42267208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice