Provider Demographics
NPI:1427041003
Name:KHATRI, HARESH H (MD)
Entity Type:Individual
Prefix:
First Name:HARESH
Middle Name:H
Last Name:KHATRI
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 1:416 N LOCUST AVE
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEBURG
Mailing Address - State:TN
Mailing Address - Zip Code:38464-3518
Mailing Address - Country:US
Mailing Address - Phone:931-762-5115
Mailing Address - Fax:931-762-5170
Practice Address - Street 1:416 N LOCUST AVE
Practice Address - Street 2:
Practice Address - City:LAWRENCEBURG
Practice Address - State:TN
Practice Address - Zip Code:38464-3518
Practice Address - Country:US
Practice Address - Phone:931-762-5115
Practice Address - Fax:931-762-5170
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-29
Last Update Date:2010-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD16313207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
A97873Medicare UPIN
3014798Medicare ID - Type Unspecified