1619921822 NPI number — BHAVNA SHARMA M.D.

Table of content: BHAVNA SHARMA M.D. (NPI 1619921822)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619921822 NPI number — BHAVNA SHARMA M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHARMA
Provider First Name:
BHAVNA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1619921822
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
102 ESSEX CT
Provider Second Line Business Mailing Address:
SUITE C
Provider Business Mailing Address City Name:
MADISON
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35758-3160
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
256-325-8457
Provider Business Mailing Address Fax Number:
256-325-8454

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12205 COUNTY LINE RD STE B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MADISON
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35758-7720
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
256-325-8457
Provider Business Practice Location Address Fax Number:
256-325-8454
Provider Enumeration Date:
05/20/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  00026846 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 51001371 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 3003 . This is a "NEIC SITE ID NUMBER" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 009932627 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".