Provider Demographics
NPI:1770711202
Name:SHARMA, MUKTA S (MD)
Entity type:Individual
Prefix:
First Name:MUKTA
Middle Name:S
Last Name:SHARMA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3018 DIXWELL AVE
Mailing Address - Street 2:ATTN: CREDENTIALING
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06518-3508
Mailing Address - Country:US
Mailing Address - Phone:203-281-5910
Mailing Address - Fax:203-281-2311
Practice Address - Street 1:3018 DIXWELL AVE
Practice Address - Street 2:ATTN: CREDENTIALING
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06518-3508
Practice Address - Country:US
Practice Address - Phone:203-281-5910
Practice Address - Fax:203-281-2311
Is Sole Proprietor?:No
Enumeration Date:2009-06-23
Last Update Date:2014-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT53061207RR0500X
NY253460207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00473038Medicaid