Provider Demographics
NPI:1780786434
Name:POLAM, SHARADHA (MD)
Entity type:Individual
Prefix:DR
First Name:SHARADHA
Middle Name:
Last Name:POLAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:SHARADHA
Other - Middle Name:
Other - Last Name:KOLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1000 HADDONFIELD BERLIN RD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-3520
Mailing Address - Country:US
Mailing Address - Phone:856-782-2212
Mailing Address - Fax:856-782-2218
Practice Address - Street 1:1 HAMILTON HEALTH PL
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:NJ
Practice Address - Zip Code:08690-3542
Practice Address - Country:US
Practice Address - Phone:609-584-6762
Practice Address - Fax:856-782-2218
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA069464002080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0024953Medicaid