Provider Demographics
NPI:1427010198
Name:HARISH, GORLI (MD)
Entity Type:Individual
Prefix:
First Name:GORLI
Middle Name:
Last Name:HARISH
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 1:10319 DORCHESTER ST
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93311-4921
Mailing Address - Country:US
Mailing Address - Phone:661-412-4031
Mailing Address - Fax:661-412-4031
Practice Address - Street 1:10319 DORCHESTER ST
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93311-4921
Practice Address - Country:US
Practice Address - Phone:661-412-4031
Practice Address - Fax:661-412-4031
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-06
Last Update Date:2018-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV10453207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0094289000Medicaid
CA4242415OtherAETNA
WVHA0463282Medicare ID - Type Unspecified