Healthcare Provider Details

I. General information

NPI: 1124251871
Provider Name (Legal Business Name): JITENDRA SHARMA M.B.B.S
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2009
Last Update Date: 10/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

513 BROOKWOOD BLVD STE 372
BIRMINGHAM AL
35209-7807
US

IV. Provider business mailing address

513 BROOKWOOD BLVD STE 372
BIRMINGHAM AL
35209-7807
US

V. Phone/Fax

Practice location:
  • Phone: 205-802-6595
  • Fax: 205-802-6598
Mailing address:
  • Phone: 205-802-6595
  • Fax: 205-802-6598

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084V0102X
TaxonomyVascular Neurology Physician
License NumberAPPLIED
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code2084V0102X
TaxonomyVascular Neurology Physician
License Number8232
License Number StateSD
# 3
Primary TaxonomyY
Taxonomy Code2084V0102X
TaxonomyVascular Neurology Physician
License Number35083
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: