Provider Demographics
NPI:1568550051
Name:SHARMA, CHANDINI (MD)
Entity Type:Individual
Prefix:
First Name:CHANDINI
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 1:3701 S HARVARD AVE STE A
Mailing Address - Street 2:PMB 389
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135-2282
Mailing Address - Country:US
Mailing Address - Phone:918-561-6642
Mailing Address - Fax:918-561-6647
Practice Address - Street 1:2025 E 71ST ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-5407
Practice Address - Country:US
Practice Address - Phone:918-561-6642
Practice Address - Fax:918-561-6647
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2014-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK24955207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200099780AMedicaid
KS2086852601Medicaid
KSH05274Medicare UPIN
KS057671Medicare ID - Type UnspecifiedMEDICARE PROVIDER NO.
OK200099780AMedicaid