Provider Demographics
NPI:1861668121
Name:VIMAL SHARMA MD INC PS
Entity Type:Organization
Organization Name:VIMAL SHARMA MD INC PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VIMAL
Authorized Official - Middle Name:
Authorized Official - Last Name:SHARMA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:509-943-5664
Mailing Address - Street 1:712 SWIFT BLVD
Mailing Address - Street 2:SUITE 8
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-3578
Mailing Address - Country:US
Mailing Address - Phone:509-943-5664
Mailing Address - Fax:509-943-5443
Practice Address - Street 1:712 SWIFT BLVD
Practice Address - Street 2:SUITE 8
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-3578
Practice Address - Country:US
Practice Address - Phone:509-943-5664
Practice Address - Fax:509-943-5443
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-06
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00032035207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1100825Medicaid
WAF91612Medicare UPIN
WAG319000318Medicare PIN