Provider Demographics
NPI:1124208129
Name:AVVERAHALLI HARISH MD PA
Entity Type:Organization
Organization Name:AVVERAHALLI HARISH MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AVVERAHALLI
Authorized Official - Middle Name:M
Authorized Official - Last Name:HARISH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-655-0312
Mailing Address - Street 1:5310 OLD COURT ROAD SUITE 303
Mailing Address - Street 2:
Mailing Address - City:RANDALLSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21133-6202
Mailing Address - Country:US
Mailing Address - Phone:410-655-0312
Mailing Address - Fax:410-655-0497
Practice Address - Street 1:5310 OLD COURT ROAD SUITE 303
Practice Address - Street 2:
Practice Address - City:RANDALLSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21133-6202
Practice Address - Country:US
Practice Address - Phone:410-655-0312
Practice Address - Fax:410-655-0497
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-07
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD42723207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty