Basic Information
| Provider Information | |||||||||
| NPI: | 1669764437 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PONDICHERRY-HARISH | ||||||||
| FirstName: | ROJA | ||||||||
| MiddleName: | CHANDRASHEKHAR | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4645 NW 8TH AVE | ||||||||
| Address2: | |||||||||
| City: | GAINESVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 326054524 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3523751212 | ||||||||
| FaxNumber: | 3523714650 | ||||||||
| Practice Location | |||||||||
| Address1: | 4645 NW 8TH AVE | ||||||||
| Address2: | |||||||||
| City: | GAINESVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 32605 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3523751212 | ||||||||
| FaxNumber: | 3523714650 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/11/2011 | ||||||||
| LastUpdateDate: | 07/03/2018 | ||||||||
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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 | 207R00000X | TRN16036 | FL | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RC0000X | ME136583 | FL | N | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | 207RI0011X | ME136583 | FL | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Interventional Cardiology |
No ID Information.