Provider Demographics
NPI:1700867975
Name:SHARMA, NUTAN (MD PHD)
Entity Type:Individual
Prefix:DR
First Name:NUTAN
Middle Name:
Last Name:SHARMA
Suffix:
Gender:F
Credentials:MD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:149 13TH STREET
Mailing Address - Street 2:ROOM 6407
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-9142
Mailing Address - Country:US
Mailing Address - Phone:617-724-9234
Mailing Address - Fax:617-726-9422
Practice Address - Street 1:15 PARKMAN ST
Practice Address - Street 2:WAC 835
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-3117
Practice Address - Country:US
Practice Address - Phone:617-726-5532
Practice Address - Fax:617-726-4101
Is Sole Proprietor?:No
Enumeration Date:2005-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1607472084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA160747OtherTUFTS HEALTH PLAN
MAJ23043OtherBCBS MA
MA0115151Medicaid
MA0115151Medicaid
MAA31768Medicare ID - Type Unspecified