Basic Information
| Provider Information | |||||||||
| NPI: | 1154394799 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SHARMA | ||||||||
| FirstName: | ASHISH | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3012 S DURANGO DR | ||||||||
| Address2: | SUITE 2 | ||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891179186 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7023661655 | ||||||||
| FaxNumber: | 7023854955 | ||||||||
| Practice Location | |||||||||
| Address1: | 861 CORONADO CENTER DR | ||||||||
| Address2: | #100 | ||||||||
| City: | HENDERSON | ||||||||
| State: | NV | ||||||||
| PostalCode: | 89052 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7024541322 | ||||||||
| FaxNumber: | 7024541624 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/13/2006 | ||||||||
| LastUpdateDate: | 10/27/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 8909 | NV | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 002018098 | 05 | NV | MEDICAID |