Provider Demographics
NPI:1659302560
Name:SHARATH, MURALI DHARAN (MD, FACP)
Entity Type:Individual
Prefix:DR
First Name:MURALI
Middle Name:DHARAN
Last Name:SHARATH
Suffix:
Gender:M
Credentials:MD, FACP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4534 BONNEY RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-3873
Mailing Address - Country:US
Mailing Address - Phone:757-499-4101
Mailing Address - Fax:
Practice Address - Street 1:4534 BONNEY RD
Practice Address - Street 2:SUITE B
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-3873
Practice Address - Country:US
Practice Address - Phone:757-499-4101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101031786207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAB60491Medicare UPIN
VA00000343Medicare ID - Type Unspecified