Provider Demographics
NPI:1558414870
Name:SHARMA, REVA (MD)
Entity Type:Individual
Prefix:
First Name:REVA
Middle Name:
Last Name:SHARMA
Suffix:
Gender:F
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:PO BOX 781076
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48278-1076
Mailing Address - Country:US
Mailing Address - Phone:317-528-4800
Mailing Address - Fax:317-865-1479
Practice Address - Street 1:7825 MCFARLAND LN
Practice Address - Street 2:SUITE B
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46237-3628
Practice Address - Country:US
Practice Address - Phone:317-889-6551
Practice Address - Fax:317-889-6651
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2021-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01046335A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN941140D6OtherMEDICARE (HOSPITALIST)
IN200181160Medicaid
INP00417858OtherMEDICARE RR (HOSPITALIST)
IN110223189OtherMEDICARE RR (OFFICE)
IN200181160Medicaid