Provider Demographics
NPI: | 1922171958 |
---|---|
Name: | SHARMA, VIVEK (MD) |
Entity Type: | Individual |
Prefix: | |
First Name: | VIVEK |
Middle Name: | |
Last Name: | SHARMA |
Suffix: | |
Gender: | M |
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: | 13000 RIVERS BEND BLVD |
Mailing Address - Street 2: | STE D |
Mailing Address - City: | CHESTER |
Mailing Address - State: | VA |
Mailing Address - Zip Code: | 23836-8632 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 804-571-5106 |
Mailing Address - Fax: | 804-530-1857 |
Practice Address - Street 1: | 325 CHARLES H DIMMOCK PKWY STE 100 |
Practice Address - Street 2: | |
Practice Address - City: | COLONIAL HEIGHTS |
Practice Address - State: | VA |
Practice Address - Zip Code: | 23834-2986 |
Practice Address - Country: | US |
Practice Address - Phone: | 804-526-5888 |
Practice Address - Fax: | 804-526-5401 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2006-11-16 |
Last Update Date: | 2017-12-05 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
PA | MD072496L | 207X00000X |
VA | 0101243516 | 207XX0005X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207XX0005X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Sports Medicine |
No | 207X00000X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
VA | 0603180002 | Medicare NSC | |
PA | H29456 | Medicare UPIN |