Provider Demographics
NPI:1710198494
Name:MATIPPA, SHARMILA (MD)
Entity Type:Individual
Prefix:DR
First Name:SHARMILA
Middle Name:
Last Name:MATIPPA
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 1:11111 YELLOW LEAF WAY
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20876-1376
Mailing Address - Country:US
Mailing Address - Phone:301-915-7507
Mailing Address - Fax:
Practice Address - Street 1:621 KELLY RD
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-2878
Practice Address - Country:US
Practice Address - Phone:301-723-3940
Practice Address - Fax:301-723-3941
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2019-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD036546207Q00000X
VA0101240670207Q00000X
MDD65186207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine