Provider Demographics
NPI:1023196839
Name:HARNOOR, ANJANA VINAYAK (MD)
Entity Type:Individual
Prefix:
First Name:ANJANA
Middle Name:VINAYAK
Last Name:HARNOOR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ANJANA
Other - Middle Name:
Other - Last Name:SRIDHAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3553 WHIPPLE RD
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94587-1507
Mailing Address - Country:US
Mailing Address - Phone:510-675-4013
Mailing Address - Fax:
Practice Address - Street 1:3553 WHIPPLE RD
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:CA
Practice Address - Zip Code:94587-1507
Practice Address - Country:US
Practice Address - Phone:510-675-4013
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA80107207R00000X, 207RE0101X
NC2011-00626207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1023196839Medicaid
CA00A801070Medicaid
NC19J3ZOtherBCBS OF NC
CA00A801070Medicaid
NC1023196839Medicaid