Provider Demographics
NPI:1538504949
Name:SHARMA, VIPUL (MD)
Entity Type:Individual
Prefix:DR
First Name:VIPUL
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 1:121 PROGRESS AVE STE 120
Mailing Address - Street 2:
Mailing Address - City:POTTSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17901-2968
Mailing Address - Country:US
Mailing Address - Phone:570-622-5616
Mailing Address - Fax:570-622-5618
Practice Address - Street 1:121 PROGRESS AVE STE 120
Practice Address - Street 2:
Practice Address - City:POTTSVILLE
Practice Address - State:PA
Practice Address - Zip Code:17901-2968
Practice Address - Country:US
Practice Address - Phone:570-622-5616
Practice Address - Fax:570-622-5618
Is Sole Proprietor?:No
Enumeration Date:2013-04-30
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD464412207QS0010X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine