Provider Demographics
NPI:1306047154
Name:SHARMA, SUMIT (MD)
Entity type:Individual
Prefix:
First Name:SUMIT
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 1:1395 NW 167TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33169-5710
Mailing Address - Country:US
Mailing Address - Phone:614-702-7915
Mailing Address - Fax:614-965-6534
Practice Address - Street 1:50 N WILSON RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43204-1214
Practice Address - Country:US
Practice Address - Phone:614-702-7915
Practice Address - Fax:614-965-6534
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA37258207R00000X
OH35.094650207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1891887790OtherFACILITY FQHC NPI #
OH0873783OtherFACILITY MEDICAID #
3618391OtherPRACTICE FACILITY PTAN #
OH1760659171OtherFACILITY FEE FOR SERVICE NPI #
OH2920683Medicaid
3618391OtherPRACTICE FACILITY PTAN #