Provider Demographics
NPI:1598704181
Name:SHARMA, MAHENDRA (MD)
Entity Type:Individual
Prefix:DR
First Name:MAHENDRA
Middle Name:
Last Name:SHARMA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:760 BROADWAY, ROOM #2B230 DEPARTMENT OF MANAGED CARE
Mailing Address - Street 2:WOODHULL MEDICAL CENTER.
Mailing Address - City:BROOKLYN.
Mailing Address - State:NY
Mailing Address - Zip Code:11206
Mailing Address - Country:US
Mailing Address - Phone:718-630-3129
Mailing Address - Fax:845-338-5616
Practice Address - Street 1:760 BROADWAY
Practice Address - Street 2:WOODHULL MEDICAL AND MENTAL HEALTH CENTER
Practice Address - City:BKLYN
Practice Address - State:NY
Practice Address - Zip Code:11206
Practice Address - Country:US
Practice Address - Phone:718-963-8000
Practice Address - Fax:718-630-3122
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2014-05-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY1988232085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02129091Medicaid
NY301T91Medicare PIN