Healthcare Provider Details

I. General information

NPI: 1639183007
Provider Name (Legal Business Name): SUSHEEL K SHARMA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 07/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 MADISON PARK DR
GLEN BURNIE MD
21061-5881
US

IV. Provider business mailing address

1401 MADISON PARK DR
GLEN BURNIE MD
21061-5881
US

V. Phone/Fax

Practice location:
  • Phone: 410-761-8007
  • Fax:
Mailing address:
  • Phone: 410-761-8007
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number0045249
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: