Healthcare Provider Details

I. General information

NPI: 1174757652
Provider Name (Legal Business Name): RAJEEV SHARMA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2009
Last Update Date: 05/14/2024
Certification Date: 05/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MEDICAL CENTER DRIVE PO BOX 9238
MORGANTOWN WV
26506
US

IV. Provider business mailing address

1 MEDICAL CENTER DRIVE PO BOX 9238
MORGANTOWN WV
26506
US

V. Phone/Fax

Practice location:
  • Phone: 304-293-1253
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204F00000X
TaxonomyTransplant Surgery Physician
License Number33019
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number18736
License Number StateNV
# 3
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number4301503086
License Number StateMI
# 4
Primary TaxonomyN
Taxonomy Code204F00000X
TaxonomyTransplant Surgery Physician
License Number18736
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: