Provider Demographics
NPI:1497798342
Name:SHARMA, OM DUTT (MD)
Entity Type:Individual
Prefix:
First Name:OM
Middle Name:DUTT
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 1:144 BRANDYWINE CIR
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:34223-1953
Mailing Address - Country:US
Mailing Address - Phone:941-475-1998
Mailing Address - Fax:
Practice Address - Street 1:1885 ENGLEWOOD RD
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:FL
Practice Address - Zip Code:34223-1822
Practice Address - Country:US
Practice Address - Phone:941-475-8291
Practice Address - Fax:941-473-3609
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2009-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0074531207R00000X
IN01047666207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL261847800Medicaid
FL261847800Medicaid
FL42576YMedicare ID - Type Unspecified