Provider Demographics
NPI:1649250895
Name:SHARMA, SANJEEV (MD)
Entity type:Individual
Prefix:DR
First Name:SANJEEV
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:PO BOX 3158
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208-3158
Mailing Address - Country:US
Mailing Address - Phone:541-732-7850
Mailing Address - Fax:541-732-7851
Practice Address - Street 1:940 ROYAL AVE
Practice Address - Street 2:SUITE 450
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-6193
Practice Address - Country:US
Practice Address - Phone:541-732-7850
Practice Address - Fax:541-732-7851
Is Sole Proprietor?:No
Enumeration Date:2006-01-21
Last Update Date:2010-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-088274208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G85988Medicaid
OH364004OtherWELLCARE
OH751011OtherBUCKEYE
OH000000503671OtherANTHEM
OH000000221392OtherUNISON
OH2695650Medicaid
OH7164035OtherAETNA
CAF89424Medicare UPIN
OHP00372967Medicare PIN
OHSH4194532Medicare UPIN
OH7164035OtherAETNA