Provider Demographics
NPI:1588645196
Name:SHARMA, PARDEEP K (MD)
Entity Type:Individual
Prefix:MR
First Name:PARDEEP
Middle Name:K
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 1:221 N OAK AVE
Mailing Address - Street 2:
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38501-2437
Mailing Address - Country:US
Mailing Address - Phone:931-646-0880
Mailing Address - Fax:931-646-0884
Practice Address - Street 1:221 N OAK AVE
Practice Address - Street 2:
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-2437
Practice Address - Country:US
Practice Address - Phone:931-646-0880
Practice Address - Fax:931-646-0884
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-10
Last Update Date:2013-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200400596207Q00000X
TN40259207Q00000X
TNMD40259207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCP00191686OtherRAILROAD MEDICARE
TN1515522Medicaid
NC1375MOtherBCBS NC
NC891375MMedicaid
NC2034221Medicare ID - Type Unspecified
TN33367133Medicare Oscar/Certification
TN33367132Medicare PIN
NCP00191686OtherRAILROAD MEDICARE
NC1375MOtherBCBS NC