Provider Demographics
NPI:1619207008
Name:NAGARAJ, SHARITA (MD)
Entity Type:Individual
Prefix:
First Name:SHARITA
Middle Name:
Last Name:NAGARAJ
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 1:711 TROY SCHENECTADY RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:LATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12110-2442
Mailing Address - Country:US
Mailing Address - Phone:518-782-3700
Mailing Address - Fax:518-782-3799
Practice Address - Street 1:713 TROY SCHENECTADY RD
Practice Address - Street 2:SUITE 310
Practice Address - City:LATHAM
Practice Address - State:NY
Practice Address - Zip Code:12110-2490
Practice Address - Country:US
Practice Address - Phone:518-783-3110
Practice Address - Fax:518-783-7890
Is Sole Proprietor?:No
Enumeration Date:2010-01-06
Last Update Date:2015-10-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY280908208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04198472Medicaid
NYJ400244220Medicare PIN