Provider Demographics
NPI:1215000989
Name:PABBATHI, HARITHA (MD)
Entity Type:Individual
Prefix:
First Name:HARITHA
Middle Name:
Last Name:PABBATHI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 SMITH ST
Mailing Address - Street 2:
Mailing Address - City:LAGRANGE
Mailing Address - State:GA
Mailing Address - Zip Code:30240-2745
Mailing Address - Country:US
Mailing Address - Phone:706-882-8831
Mailing Address - Fax:
Practice Address - Street 1:2221 NOLL DR FL 1
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17603-7614
Practice Address - Country:US
Practice Address - Phone:717-715-1001
Practice Address - Fax:717-531-0849
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD61396150207RH0000X, 207RX0202X
LA333029207RH0003X
GA064236207RH0003X
PAMD482881207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematology
No207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA437026508IMedicaid
MO200122481Medicaid
SC287255Medicaid