Healthcare Provider Details

I. General information

NPI: 1942637095
Provider Name (Legal Business Name): MAYUR SHARMA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2013
Last Update Date: 05/28/2025
Certification Date: 05/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 MEDICAL CENTER DRIVE SUITE B500
HUNTINGTON WV
25701-3655
US

IV. Provider business mailing address

1448 10TH AVENUE SUITE 304
HUNTINGTON WV
25701-3579
US

V. Phone/Fax

Practice location:
  • Phone: 304-691-1787
  • Fax: 304-691-8711
Mailing address:
  • Phone: 304-691-6381
  • Fax: 304-691-8591

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number57.022638
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number34862
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: