Provider Demographics
NPI:1477872885
Name:SHARMA, RAGHAV (MD)
Entity Type:Individual
Prefix:
First Name:RAGHAV
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 1:1035 N ORLANDO AVE STE 205
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-2213
Mailing Address - Country:US
Mailing Address - Phone:321-274-8701
Mailing Address - Fax:321-274-8702
Practice Address - Street 1:1035 N ORLANDO AVE STE 205
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-2213
Practice Address - Country:US
Practice Address - Phone:321-274-8701
Practice Address - Fax:321-274-8702
Is Sole Proprietor?:No
Enumeration Date:2010-05-25
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY272390207R00000X
PAMT197908208600000X
FLME139953207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL103621700Medicaid
FLQH446OtherHF MA