1114214459 NPI number — DR. MANU SHARMA MD

Table of content: DR. MANU SHARMA MD (NPI 1114214459)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114214459 NPI number — DR. MANU SHARMA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHARMA
Provider First Name:
MANU
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1114214459
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/31/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3301 QUARRY DRIVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FAYETTEVILLE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28303
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
646-318-4992
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3436 N MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOPE MILLS
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28348-1834
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-426-7337
Provider Business Practice Location Address Fax Number:
910-424-1418
Provider Enumeration Date:
07/07/2011

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: 208000000X , with the licence number:  2011-01109 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 208000000X , with the licence number: 201101109 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 1114214459 . This is a "HEALTHSMART" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 1114214459 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4015451 . This is a "COVENTRY NATIONAL - COVENTRY PPO" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 9777745 . This is a "AETNA" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 1114214459 . This is a "HUMANA" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 1305465 . This is a "COVENTRY OF THE CAROLINAS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 1305465 . This is a "1ST HEALTH" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 4015451 . This is a "GEHA/MAILHANDLERS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 1114214459 . This is a "HEALTHNET FEDERAL SERVICES" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 13037216 . This is a "PHCS-MULTIPLAN" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 1965107 . This is a "CIGNA-GREATWEST" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 167VJ . This is a "BCBS OF NC" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 1305465 . This is a "WELLPATH" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 237960 . This is a "MEDCOST" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 3369235 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: FH1101535 . This is a "FIRST CAROLINA CARE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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