Provider Demographics
NPI:1285700369
Name:SHARMA, MUDIT (MD)
Entity type:Individual
Prefix:MR
First Name:MUDIT
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 1:9625 SURVEYOR COURT
Mailing Address - Street 2:SUITE 320
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20110
Mailing Address - Country:US
Mailing Address - Phone:571-921-4877
Mailing Address - Fax:571-208-0585
Practice Address - Street 1:9625 SURVEYOR COURT
Practice Address - Street 2:SUITE 320
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110
Practice Address - Country:US
Practice Address - Phone:571-921-4877
Practice Address - Fax:571-208-0585
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2022-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD035546207T00000X
VA0101241433207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0101241433OtherMEDICAL LICENSE
DCMD035546OtherMEDICAL LICENSE