Provider Demographics
NPI:1164441242
Name:TANKALA, HARSHA (MD)
Entity Type:Individual
Prefix:DR
First Name:HARSHA
Middle Name:
Last Name:TANKALA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:319 QUAILS NEST DR
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19904-5586
Mailing Address - Country:US
Mailing Address - Phone:302-678-0950
Mailing Address - Fax:
Practice Address - Street 1:1125 FORREST AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19904-3483
Practice Address - Country:US
Practice Address - Phone:302-346-0101
Practice Address - Fax:302-346-0103
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC1-0005962207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0001058401Medicaid
H29530Medicare UPIN
DE0001058401Medicaid