Provider Demographics
NPI:1164591889
Name:SHARMA, PRATIMA J (MD)
Entity Type:Individual
Prefix:
First Name:PRATIMA
Middle Name:J
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:PO BOX 110456
Mailing Address - Street 2:MS 13739
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98411-0456
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12333 NE 130TH LN
Practice Address - Street 2:STE 310
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034
Practice Address - Country:US
Practice Address - Phone:425-899-6700
Practice Address - Fax:425-899-6701
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00039053207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA147279OtherLABOR & INDUSTRY
WA2927SHOtherREGENCE HEALTH
WAGAB22613Medicare PIN
WA2927SHOtherREGENCE HEALTH