Basic Information
| Provider Information | |||||||||
| NPI: | 1699773457 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DULAMAL | ||||||||
| FirstName: | HARRESH | ||||||||
| MiddleName: | BHAGWANDAS | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | DULAMAL | ||||||||
| OtherFirstName: | HARRESH | ||||||||
| OtherMiddleName: | BHAGWANDAS | ||||||||
| OtherNamePrefix: | DR. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | M.D. | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 9 CHATHAM CTR S | ||||||||
| Address2: | SUITE C | ||||||||
| City: | SAVANNAH | ||||||||
| State: | GA | ||||||||
| PostalCode: | 314057456 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9125277211 | ||||||||
| FaxNumber: | 9125277222 | ||||||||
| Practice Location | |||||||||
| Address1: | 9 CHATHAM CTR S | ||||||||
| Address2: | SUITE C | ||||||||
| City: | SAVANNAH | ||||||||
| State: | GA | ||||||||
| PostalCode: | 314057456 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9125277211 | ||||||||
| FaxNumber: | 9125277222 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/14/2005 | ||||||||
| LastUpdateDate: | 06/25/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
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| AuthorizedOfficialNameSuffix: | |||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 038474 | GA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 681676 | 01 | GA | BLUECROSS BLUESHIELD | OTHER | 000612048C | 05 | GA | MEDICAID | G38474 | 05 | SC | MEDICAID | 080088386 | 01 | GA | RR MEDICARE | OTHER |