Healthcare Provider Details

I. General information

NPI: 1043979834
Provider Name (Legal Business Name): SUPARNA SHARMA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/09/2021
Last Update Date: 12/17/2021
Certification Date: 12/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

295 VARNUM AVE
LOWELL MA
01854-2134
US

IV. Provider business mailing address

800 WASHINGTON ST # 7051
BOSTON MA
02111-1552
US

V. Phone/Fax

Practice location:
  • Phone: 978-937-6000
  • Fax:
Mailing address:
  • Phone: 617-636-5314
  • Fax: 617-636-8391

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number290116
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD461271
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: