Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 214968-1 | NY |
NPI | 1003807041 |
---|---|
Provider Name | Virendra Sharma |
First Address | Utica, NY 13501-4308 |
Second Address | Utica, NY 13501-4308 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/10/2005 |
Last Update Date | 10/11/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02077172 | (05) | NY |
H08409 | (02) | NY |