MEDICARE: NAGMA SHARMA LOTT MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207QG0300X	Geriatric Medicine (Family Medicine) Physician	000956	GA
2	207QG0300X	Geriatric Medicine (Family Medicine) Physician	53551	AZ

General Provider Information

NPI Number	:	1619155181
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NAGMA SHARMA LOTT MD

Provider Business Mailing Address
First Line	:	5112 W OLIVE AVE STE C-113
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85302-4209
Country	:	US
Telephone Number	:	623-939-8618
Fax Number	:	623-939-9184

Provider Business Practice Location Address
First Line	:	5112 W OLIVE AVE STE C-113
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85302-4209
Country	:	US
Telephone Number	:	623-939-8618
Fax Number	:	623-939-9184

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/06/2008
Last Update Date	:	07/07/2019

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