Healthcare Provider Details

I. General information

NPI: 1063446474
Provider Name (Legal Business Name): TANVI S SHARMA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 09/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 LONGWOOD AVE LO-650
BOSTON MA
02115-5724
US

IV. Provider business mailing address

300 LONGWOOD AVE LO-650
BOSTON MA
02115-5724
US

V. Phone/Fax

Practice location:
  • Phone: 617-355-5738
  • Fax:
Mailing address:
  • Phone: 617-355-5738
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME88380
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code2080P0208X
TaxonomyPediatric Infectious Diseases Physician
License NumberME88380
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: