Healthcare Provider Details

I. General information

NPI: 1861668121
Provider Name (Legal Business Name): VIMAL SHARMA MD INC PS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2008
Last Update Date: 05/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

712 SWIFT BLVD SUITE 8
RICHLAND WA
99352-3578
US

IV. Provider business mailing address

712 SWIFT BLVD SUITE 8
RICHLAND WA
99352-3578
US

V. Phone/Fax

Practice location:
  • Phone: 509-943-5664
  • Fax: 509-943-5443
Mailing address:
  • Phone: 509-943-5664
  • Fax: 509-943-5443

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD00032035
License Number StateWA

VIII. Authorized Official

Name: VIMAL SHARMA
Title or Position: OWNER
Credential: MD
Phone: 509-943-5664