Provider Demographics
NPI:1386676484
Name:SHARMA, MOHAN (MD)
Entity Type:Individual
Prefix:
First Name:MOHAN
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 1:276 SMITHTOWN BLVD
Mailing Address - Street 2:
Mailing Address - City:NESCONSET
Mailing Address - State:NY
Mailing Address - Zip Code:11767-2084
Mailing Address - Country:US
Mailing Address - Phone:631-981-9143
Mailing Address - Fax:631-981-6710
Practice Address - Street 1:276 SMITHTOWN BLVD
Practice Address - Street 2:
Practice Address - City:NESCONSET
Practice Address - State:NY
Practice Address - Zip Code:11767-2084
Practice Address - Country:US
Practice Address - Phone:631-981-9143
Practice Address - Fax:631-981-6710
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2012-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY209585207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0105GJMedicare ID - Type Unspecified
G29388Medicare UPIN