Provider Demographics
NPI:1861491680
Name:ROSHAN SHARMA, M.D., P.A.
Entity Type:Organization
Organization Name:ROSHAN SHARMA, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ROSHAN
Authorized Official - Middle Name:LAL
Authorized Official - Last Name:SHARMA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:903-793-0669
Mailing Address - Street 1:520 TEXAS BLVD
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75501-5538
Mailing Address - Country:US
Mailing Address - Phone:903-793-0669
Mailing Address - Fax:903-792-1914
Practice Address - Street 1:520 TEXAS BLVD
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75501-5538
Practice Address - Country:US
Practice Address - Phone:903-793-0669
Practice Address - Fax:903-792-1914
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMDJ0673208100000X, 2081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Not Answered2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5M261Medicare ID - Type UnspecifiedAR MEDICARE
TXC49619Medicare UPIN
TX00W201Medicare ID - Type UnspecifiedTEXAS MEDICARE