Provider Demographics
NPI:1194786194
Name:SHARMA, VIBHAVASU (MD)
Entity type:Individual
Prefix:
First Name:VIBHAVASU
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 1:200 MILL RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:FAIRHAVEN
Mailing Address - State:MA
Mailing Address - Zip Code:02719-5252
Mailing Address - Country:US
Mailing Address - Phone:508-985-5020
Mailing Address - Fax:508-985-5038
Practice Address - Street 1:1071 KEMPTON ST.
Practice Address - Street 2:SUITE 210
Practice Address - City:NEW BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02740
Practice Address - Country:US
Practice Address - Phone:508-961-1500
Practice Address - Fax:508-961-2413
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2012-04-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35087961207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2657692Medicaid
OH7382101Medicare PIN
OH4187191Medicare PIN
OH2657692Medicaid
OHI56531Medicare UPIN