Provider Demographics
NPI:1306947999
Name:SHARMA, RAVINDER (MD)
Entity type:Individual
Prefix:
First Name:RAVINDER
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 1:21 CLYDE RD STE 102
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08873-5043
Mailing Address - Country:US
Mailing Address - Phone:732-745-1100
Mailing Address - Fax:732-369-9057
Practice Address - Street 1:21 CLYDE RD STE 102
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:NJ
Practice Address - Zip Code:08873-5043
Practice Address - Country:US
Practice Address - Phone:732-745-1100
Practice Address - Fax:732-369-9057
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2019-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05732100207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0041408Medicaid
F26020Medicare UPIN