Provider Demographics
NPI:1962561589
Name:SHARMA, PRATIBHA (MD)
Entity type:Individual
Prefix:DR
First Name:PRATIBHA
Middle Name:
Last Name:SHARMA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3001 SOUTH HANOVER
Mailing Address - Street 2:SUITE 203
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21225
Mailing Address - Country:US
Mailing Address - Phone:410-355-1108
Mailing Address - Fax:410-350-2065
Practice Address - Street 1:3001 SOUTH HANOVER
Practice Address - Street 2:SUITE 203
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21225
Practice Address - Country:US
Practice Address - Phone:410-355-1108
Practice Address - Fax:410-350-2065
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2012-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0052205207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD145800100Medicaid
317RMedicare ID - Type Unspecified
G66888Medicare UPIN