Healthcare Provider Details

I. General information

NPI: 1033372792
Provider Name (Legal Business Name): RAJIV SHARMA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2008
Last Update Date: 04/24/2025
Certification Date: 04/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 KINGS HWY E STE 109
FAIRFIELD CT
06825-4871
US

IV. Provider business mailing address

PO BOX 416139
BOSTON MA
02241-6139
US

V. Phone/Fax

Practice location:
  • Phone: 203-330-0248
  • Fax:
Mailing address:
  • Phone: 610-644-8900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number0101285548
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberME125156
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number4301092974
License Number StateMI
# 4
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number64620
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: