Provider Demographics
NPI:1417003385
Name:HARSH, RENUKA SHIV (MD)
Entity Type:Individual
Prefix:
First Name:RENUKA
Middle Name:SHIV
Last Name:HARSH
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 1:218 FOUST ST STE B
Mailing Address - Street 2:
Mailing Address - City:ASHEBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27203-5476
Mailing Address - Country:US
Mailing Address - Phone:336-626-2793
Mailing Address - Fax:336-626-4737
Practice Address - Street 1:218 FOUST ST STE B
Practice Address - Street 2:
Practice Address - City:ASHEBORO
Practice Address - State:NC
Practice Address - Zip Code:27203-5476
Practice Address - Country:US
Practice Address - Phone:336-626-2793
Practice Address - Fax:336-626-4737
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC309852080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC40154OtherBLUE CROSS BLUE SHEILD NC
NC8940154Medicaid
NCF45748Medicare UPIN