Provider Demographics
NPI:1194822783
Name:SHARMA, GOPESH KUMAR (MD)
Entity Type:Individual
Prefix:
First Name:GOPESH
Middle Name:KUMAR
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 1:8303 ARLINGTON BLVD STE 203
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-2903
Mailing Address - Country:US
Mailing Address - Phone:703-573-3177
Mailing Address - Fax:703-573-3780
Practice Address - Street 1:8303 ARLINGTON BLVD STE 203
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-2903
Practice Address - Country:US
Practice Address - Phone:703-573-3177
Practice Address - Fax:703-573-3780
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-17
Last Update Date:2008-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101031013207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA4091828OtherAETNA
VA202010595OtherCIGNA
VA274366OtherANTHEM
VA0360OtherCAREFIRST BLUE CROSS BLUE SHIELD
VA202010595OtherCIGNA