Provider Demographics
NPI:1477618528
Name:SHARMA, KUNJBALA (MD)
Entity type:Individual
Prefix:
First Name:KUNJBALA
Middle Name:
Last Name:SHARMA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:KUNJBALA
Other - Middle Name:
Other - Last Name:SHARMA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:39 EAST AVE
Mailing Address - Street 2:BLACKSTONE VALLEY COMMUNITY HEALTH CARE
Mailing Address - City:PAWTUCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02860-4003
Mailing Address - Country:US
Mailing Address - Phone:401-722-0081
Mailing Address - Fax:401-312-0318
Practice Address - Street 1:1145 MAIN ST
Practice Address - Street 2:
Practice Address - City:PAWTUCKET
Practice Address - State:RI
Practice Address - Zip Code:02860-4807
Practice Address - Country:US
Practice Address - Phone:401-722-0081
Practice Address - Fax:401-312-0318
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2019-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA39079208000000X, 208D00000X
RIMD07897207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI400561OtherBC BS OF RI (BLUECHIP)
MA9765239Medicaid
RI400561OtherBC BS OF RI
MA961244-01OtherNETWORK HEALTH
MAE05285OtherBC BS OF MA
MAE05285Medicare ID - Type Unspecified
MA9765239Medicaid