MEDICARE: RAINBOW MEDICAL HOME PEDIATRICS, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	140437	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1215243449
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RAINBOW MEDICAL HOME PEDIATRICS, LLC

Provider Business Mailing Address
First Line	:	4415 BUFFALO RD
Second Line	:
City	:	NORTH CHILI
State	:	NY
Zip	:	14514-1024
Country	:	US
Telephone Number	:	585-594-5008
Fax Number	:	585-594-1003

Provider Business Practice Location Address
First Line	:	4415 BUFFALO RD
Second Line	:
City	:	NORTH CHILI
State	:	NY
Zip	:	14514-1024
Country	:	US
Telephone Number	:	585-594-5008
Fax Number	:	585-594-1003

Authorized Official
Title or Position	:	OWNER
Name	:	DR. PIUSH SHARMA
Credential	:	MD
Telephone Number	:	585-594-5008

Provider Enumeration Date	:	08/25/2010
Last Update Date	:	08/25/2010

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