Provider Demographics
NPI:1164409884
Name:SHARMA, SANJEEV S (MD)
Entity Type:Individual
Prefix:
First Name:SANJEEV
Middle Name:S
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:PO BOX 1104
Mailing Address - Street 2:
Mailing Address - City:RAHWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:07065-1104
Mailing Address - Country:US
Mailing Address - Phone:973-444-2664
Mailing Address - Fax:973-322-4132
Practice Address - Street 1:2900 1ST AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25702-1241
Practice Address - Country:US
Practice Address - Phone:304-526-1143
Practice Address - Fax:304-526-8945
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2011-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV190772085R0001X
KY306822085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY6400573900Medicaid
OH000000200071OtherUNISON
WV900002277OtherRR MEDICARE (WV)
001718779OtherMTN STATE BC BS
WV0122133000Medicaid
OH2018711Medicaid
WV550493376 00OtherWORKMANS COMP
KY50007263OtherPASSPORT
5123739OtherAETNA
5123739OtherAETNA
G72447Medicare UPIN