Provider Demographics
NPI:1467493734
Name:SHARMA, OM PRAKASH (MD)
Entity Type:Individual
Prefix:
First Name:OM
Middle Name:PRAKASH
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 1:2100 LEHIGH ST
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18042-3830
Mailing Address - Country:US
Mailing Address - Phone:610-253-3551
Mailing Address - Fax:610-253-1043
Practice Address - Street 1:2100 LEHIGH ST
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18042-3830
Practice Address - Country:US
Practice Address - Phone:610-253-3551
Practice Address - Fax:610-253-1043
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2020-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD 037664L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA138256OtherHIGHMARK BLUE SHIELD
PA138256OtherHIGHMARK BLUE SHIELD
PAB38883Medicare UPIN