Provider Demographics
NPI:1003195314
Name:HARBOR INTERNAL MEDICINE
Entity Type:Organization
Organization Name:HARBOR INTERNAL MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEVINA
Authorized Official - Middle Name:
Authorized Official - Last Name:TALWAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:704-660-0321
Mailing Address - Street 1:478 WILLIAMSON RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-8192
Mailing Address - Country:US
Mailing Address - Phone:704-660-0321
Mailing Address - Fax:704-660-0765
Practice Address - Street 1:478 WILLIAMSON RD
Practice Address - Street 2:SUITE B
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-8192
Practice Address - Country:US
Practice Address - Phone:704-660-0321
Practice Address - Fax:704-660-0765
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-04
Last Update Date:2011-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2009-01402207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty