MEDICARE: GAUTAM SHARMA

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	207Q00000X	Family Medicine Physician	OT019545	PA
2	207Q00000X	Family Medicine Physician	317425	NY

General Provider Information

NPI Number	:	1760043970
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GAUTAM SHARMA

Provider Business Mailing Address
First Line	:	7218 164TH ST
Second Line	:
City	:	FRESH MEADOWS
State	:	NY
Zip	:	11365-4222
Country	:	US
Telephone Number	:	718-969-6640
Fax Number	:

Provider Business Practice Location Address
First Line	:	7218 164TH ST
Second Line	:
City	:	FRESH MEADOWS
State	:	NY
Zip	:	11365-4222
Country	:	US
Telephone Number	:	718-969-6640
Fax Number	:

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

Provider Enumeration Date	:	06/27/2019
Last Update Date	:	10/03/2024

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Directions to “ GAUTAM SHARMA ” Practice Location

Language	Start Address	Practice Location

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