Basic Information
| Provider Information | |||||||||
| NPI: | 1124208129 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | AVVERAHALLI HARISH MD PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5310 OLD COURT ROAD SUITE 303 | ||||||||
| Address2: | |||||||||
| City: | RANDALLSTOWN | ||||||||
| State: | MD | ||||||||
| PostalCode: | 211336202 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4106550312 | ||||||||
| FaxNumber: | 4106550497 | ||||||||
| Practice Location | |||||||||
| Address1: | 5310 OLD COURT ROAD SUITE 303 | ||||||||
| Address2: | |||||||||
| City: | RANDALLSTOWN | ||||||||
| State: | MD | ||||||||
| PostalCode: | 211336202 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4106550312 | ||||||||
| FaxNumber: | 4106550497 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/07/2007 | ||||||||
| LastUpdateDate: | 11/07/2007 | ||||||||
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| AuthorizedOfficialLastName: | HARISH | ||||||||
| AuthorizedOfficialFirstName: | AVVERAHALLI | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 4106550312 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | D42723 | MD | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.