Provider Demographics
NPI:1447200332
Name:HARIHARAN, ANANDOM (MD)
Entity Type:Individual
Prefix:
First Name:ANANDOM
Middle Name:
Last Name:HARIHARAN
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 1:1329 LUSITANA ST
Mailing Address - Street 2:SUITE 602
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-2431
Mailing Address - Country:US
Mailing Address - Phone:808-522-5055
Mailing Address - Fax:808-524-6306
Practice Address - Street 1:670 PONAHAWAI ST
Practice Address - Street 2:SUITE 118
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-2660
Practice Address - Country:US
Practice Address - Phone:808-961-0151
Practice Address - Fax:808-961-5993
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2009-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD1948208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI030810-02Medicaid
HIMD1948OtherHAWAII LICENSE NUMBER
HIMD1948OtherHAWAII LICENSE NUMBER
HIC97424Medicare UPIN