Provider Demographics
NPI:1417037847
Name:SEETHAMRAJU, HARISH (MD)
Entity Type:Individual
Prefix:
First Name:HARISH
Middle Name:
Last Name:SEETHAMRAJU
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 1:740 S LIMESTONE
Mailing Address - Street 2:A301
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40536-0284
Mailing Address - Country:US
Mailing Address - Phone:859-323-6494
Mailing Address - Fax:859-257-4682
Practice Address - Street 1:740 S LIMESTONE
Practice Address - Street 2:A301
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40536-0284
Practice Address - Country:US
Practice Address - Phone:859-323-6494
Practice Address - Fax:859-257-4682
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2013-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL7879207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX163955101Medicaid
TX1417037847OtherBLUE CROSS BLUE SHIELD
TX163955103Medicaid
LA1807842OtherLA MEDICAID
TXP01023534OtherMEDICARE RR
TXP01023534OtherMEDICARE RR
TX163955101Medicaid
TX8B6008Medicare PIN