Healthcare Provider Details

I. General information

NPI: 1801859939
Provider Name (Legal Business Name): SURESH R SHAROFF M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2006
Last Update Date: 01/07/2021
Certification Date: 01/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7287 SAWMILL RD SUITE 100
DUBLIN OH
43016-9021
US

IV. Provider business mailing address

9800 SHELBYVILLE RD STE 220
LOUISVILLE KY
40223-2992
US

V. Phone/Fax

Practice location:
  • Phone: 614-760-0099
  • Fax: 855-656-7325
Mailing address:
  • Phone: 502-429-8585
  • Fax: 855-656-7325

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License Number35051349S
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number35.051349
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: