Provider Demographics
NPI:1114975562
Name:SHARMA, KONARK (MD)
Entity Type:Individual
Prefix:
First Name:KONARK
Middle Name:
Last Name:SHARMA
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 1:365 LENNON LN
Mailing Address - Street 2:200
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-5910
Mailing Address - Country:US
Mailing Address - Phone:925-947-2334
Mailing Address - Fax:925-947-5889
Practice Address - Street 1:365 LENNON LN
Practice Address - Street 2:200
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-5910
Practice Address - Country:US
Practice Address - Phone:925-947-2334
Practice Address - Fax:925-947-5889
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2014-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA118942207RI0200X, 207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1114975562Medicaid
CA1134145055OtherINFECTIOUS DISEASE DOCTORS MEDICAL GROUP
CAI21648Medicare UPIN
NVV105792Medicare PIN
NV100008OtherOLD MEDICARE NUMBER ASSIGNED 10/1/04, CHANGED TO V105792 3/7/08
CA1134145055OtherINFECTIOUS DISEASE DOCTORS MEDICAL GROUP
NV65-1280664OtherTAX ID NUMBER