Healthcare Provider Details

I. General information

NPI: 1164409884
Provider Name (Legal Business Name): SANJEEV S SHARMA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2005
Last Update Date: 07/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 1ST AVE
HUNTINGTON WV
25702-1241
US

IV. Provider business mailing address

PO BOX 1104
RAHWAY NJ
07065-1104
US

V. Phone/Fax

Practice location:
  • Phone: 304-526-1143
  • Fax: 304-526-8945
Mailing address:
  • Phone: 973-444-2664
  • Fax: 973-322-4132

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number19077
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number30682
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: