Healthcare Provider Details

I. General information

NPI: 1467659987
Provider Name (Legal Business Name): ALKA BORA P.A.-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALKA SHARMA

II. Dates (important events)

Enumeration Date: 06/28/2007
Last Update Date: 05/11/2023
Certification Date: 05/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1833 PORTAL ST
BALTIMORE MD
21224-6518
US

IV. Provider business mailing address

6201 GREENLEIGH AVE
MIDDLE RIVER MD
21220-2004
US

V. Phone/Fax

Practice location:
  • Phone: 410-633-3604
  • Fax:
Mailing address:
  • Phone: 410-933-2704
  • Fax: 410-933-1390

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberC0003529
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: