Provider Demographics
NPI:1619093630
Name:SHARMA, PV PATHANJALI PV (MD)
Entity Type:Individual
Prefix:
First Name:PV PATHANJALI
Middle Name:PV
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 1:2500 BERNVILLE RD
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19605-9453
Mailing Address - Country:US
Mailing Address - Phone:610-378-2000
Mailing Address - Fax:610-378-2799
Practice Address - Street 1:2494 BERNVILLE ROAD
Practice Address - Street 2:SUITE 203
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19605-9453
Practice Address - Country:US
Practice Address - Phone:610-378-2499
Practice Address - Fax:610-378-2989
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2020-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD049830L2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001429364000Medicaid
PA001429364000Medicaid
PAD18612Medicare UPIN