Healthcare Provider Details

I. General information

NPI: 1538504949
Provider Name (Legal Business Name): VIPUL SHARMA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2013
Last Update Date: 09/11/2025
Certification Date: 09/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

61 INDUSTRIAL DR
HAMBURG PA
19526-8768
US

IV. Provider business mailing address

61 INDUSTRIAL DR
HAMBURG PA
19526-8768
US

V. Phone/Fax

Practice location:
  • Phone: 570-875-8035
  • Fax:
Mailing address:
  • Phone: 570-622-5616
  • Fax: 570-622-5618

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberMD464412
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberMD464412
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: