Provider Demographics
NPI:1194107623
Name:SHARMA PRIAMVADA, GARGI (MB,BS)
Entity type:Individual
Prefix:
First Name:GARGI
Middle Name:
Last Name:SHARMA PRIAMVADA
Suffix:
Gender:F
Credentials:MB,BS
Other - Prefix:
Other - First Name:GARGI
Other - Middle Name:SHARMA
Other - Last Name:PRIAMVADA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 751069
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1069
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2355 W ARLINGTON BLVD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-2847
Practice Address - Country:US
Practice Address - Phone:252-744-2545
Practice Address - Fax:252-744-1817
Is Sole Proprietor?:No
Enumeration Date:2015-06-20
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2021-01375207RN0300X
OK31599208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine