Provider Demographics
NPI:1386815389
Name:DR. GIRISH SHARMA
Entity Type:Organization
Organization Name:DR. GIRISH SHARMA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PAT
Authorized Official - Middle Name:
Authorized Official - Last Name:SHARMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-871-2636
Mailing Address - Street 1:43 W MAIN ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:VERNON ROCKVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06066-3549
Mailing Address - Country:US
Mailing Address - Phone:860-871-2636
Mailing Address - Fax:860-871-6158
Practice Address - Street 1:43 W MAIN ST
Practice Address - Street 2:SUITE 2
Practice Address - City:VERNON ROCKVILLE
Practice Address - State:CT
Practice Address - Zip Code:06066-3549
Practice Address - Country:US
Practice Address - Phone:860-871-2636
Practice Address - Fax:860-871-6158
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-18
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT028562207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT=========OtherTAX ID