Basic Information
| Provider Information | |||||||||
| NPI: | 1194014084 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SHARMA | ||||||||
| FirstName: | MADHURI | ||||||||
| MiddleName: | V | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 374 GRAND AVE | ||||||||
| Address2: | |||||||||
| City: | NEW HAVEN | ||||||||
| State: | CT | ||||||||
| PostalCode: | 065133733 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2037777411 | ||||||||
| FaxNumber: | 2037778506 | ||||||||
| Practice Location | |||||||||
| Address1: | 374 GRAND AVE | ||||||||
| Address2: | |||||||||
| City: | NEW HAVEN | ||||||||
| State: | CT | ||||||||
| PostalCode: | 065133733 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2037777411 | ||||||||
| FaxNumber: | 2037778506 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/31/2011 | ||||||||
| LastUpdateDate: | 12/28/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
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| AuthorizedOfficialTitleorPosition: | |||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 12/28/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 26190 | MS | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 241-320 | WI | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 11172 | SD | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | CDRH.0059726 | CO | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 66557 | CT | Y | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | MD.37475 | AL | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 57367 | AZ | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 64604 | MN | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | MD-45603 | IA | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | MD60900162 | WA | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 036147435 | IL | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | C1-0010988 | DE | N | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 008096869 | 05 | CT | MEDICAID | 9000158559 | 05 | CO | MEDICAID |