Basic Information
| Provider Information | |||||||||
| NPI: | 1801837117 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SHARMA | ||||||||
| FirstName: | PANKAJ | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 540 LINCOLN PARK BLVD | ||||||||
| Address2: | STE. 200 | ||||||||
| City: | DAYTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 454296401 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9372988058 | ||||||||
| FaxNumber: | 9372985638 | ||||||||
| Practice Location | |||||||||
| Address1: | 540 LINCOLN PARK BLVD | ||||||||
| Address2: | STE. 200 | ||||||||
| City: | DAYTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 454296401 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9372988058 | ||||||||
| FaxNumber: | 9372985638 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/09/2006 | ||||||||
| LastUpdateDate: | 08/25/2015 | ||||||||
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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 | 207RC0000X | 35087111 | OH | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 2618297 | 05 | OH | MEDICAID |