Provider Demographics
NPI:1194945691
Name:SHARATHKUMAR, ANJALI A (MD)
Entity type:Individual
Prefix:
First Name:ANJALI
Middle Name:A
Last Name:SHARATHKUMAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ANJALI
Other - Middle Name:A
Other - Last Name:ALATKAR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:300 HAWKINS DR
Mailing Address - Street 2:JCP 2628
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52242-1011
Mailing Address - Country:US
Mailing Address - Phone:319-384-5108
Mailing Address - Fax:319-467-5704
Practice Address - Street 1:200 HAWKINS DR
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52242-1009
Practice Address - Country:US
Practice Address - Phone:319-384-5108
Practice Address - Fax:319-356-5704
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2015-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01064575A2080P0207X
IAMD-424272080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200888810Medicaid
IN090730FFMedicare PIN
IN145590R1Medicare PIN