Basic Information
| Provider Information | |||||||||
| NPI: | 1306047154 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SHARMA | ||||||||
| FirstName: | SUMIT | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1395 NW 167TH ST | ||||||||
| Address2: | |||||||||
| City: | MIAMI GARDENS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331695710 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6147027915 | ||||||||
| FaxNumber: | 6149656534 | ||||||||
| Practice Location | |||||||||
| Address1: | 50 N WILSON RD | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432041214 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6147027915 | ||||||||
| FaxNumber: | 6149656534 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/30/2007 | ||||||||
| LastUpdateDate: | 11/23/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/23/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 37258 | IA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 35.094650 | OH | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1891887790 | 01 | OH | FACILITY FQHC NPI # | OTHER | 0873783 | 01 | OH | FACILITY MEDICAID # | OTHER | 3618391 | 01 | PRACTICE FACILITY PTAN # | OTHER | 1760659171 | 01 | OH | FACILITY FEE FOR SERVICE NPI # | OTHER | 2920683 | 05 | OH | MEDICAID |