Provider Demographics
NPI:1376635839
Name:MAGAN, SHARMARKE (MD)
Entity Type:Individual
Prefix:DR
First Name:SHARMARKE
Middle Name:
Last Name:MAGAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2555 COURT DR
Mailing Address - Street 2:SUITE 270
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-2134
Mailing Address - Country:US
Mailing Address - Phone:704-834-4390
Mailing Address - Fax:704-834-3274
Practice Address - Street 1:2555 COURT DR
Practice Address - Street 2:SUITE 270
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-2134
Practice Address - Country:US
Practice Address - Phone:704-834-4390
Practice Address - Fax:704-834-3274
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2016-10-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101243502208M00000X
ARE5399208M00000X
NC2013-01517207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1376635839Medicaid
AR440110701Medicaid
SCNC1939Medicaid
NC182AUOtherBCBS NC
NC182AUOtherBCBS NC