Provider Demographics
NPI:1568643419
Name:OM P SHARMA
Entity Type:Organization
Organization Name:OM P SHARMA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MGR
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:STYCZYNSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-730-6527
Mailing Address - Street 1:2100 LEHIGH ST
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18042-3830
Mailing Address - Country:US
Mailing Address - Phone:610-515-1830
Mailing Address - Fax:610-253-1043
Practice Address - Street 1:2100 LEHIGH ST
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18042-3830
Practice Address - Country:US
Practice Address - Phone:610-515-1830
Practice Address - Fax:610-253-1043
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-20
Last Update Date:2007-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD037664L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA088695Medicare PIN
PAB38883Medicare UPIN