Provider Demographics
NPI:1952468795
Name:SHARMA, VIMAL C (MD)
Entity Type:Individual
Prefix:
First Name:VIMAL
Middle Name:C
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 1:712 SWIFT BLVD STE 8
Mailing Address - Street 2:
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 STE 8
Practice Address - Street 2:
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
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2009-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00032035207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1100825Medicaid
WA1100825Medicaid
F91612Medicare UPIN