Provider Demographics
NPI:1154037372
Name:RAHUL SHARMA MD PLLC
Entity type:Organization
Organization Name:RAHUL SHARMA MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PEGGY
Authorized Official - Middle Name:
Authorized Official - Last Name:JETER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-583-2073
Mailing Address - Street 1:11124 W CALIFORNIA AVE
Mailing Address - Street 2:SUITE G
Mailing Address - City:YOUNGTOWN
Mailing Address - State:AZ
Mailing Address - Zip Code:85363-1246
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11124 W CALIFORNIA AVE
Practice Address - Street 2:SUITE G
Practice Address - City:YOUNGTOWN
Practice Address - State:AZ
Practice Address - Zip Code:85363-1246
Practice Address - Country:US
Practice Address - Phone:623-583-2073
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RAHUL SHARMA MD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-01-31
Last Update Date:2023-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ087103Medicaid