Provider Demographics
NPI: | 1669440186 |
---|---|
Name: | NARAHARI, PREMNATH (MD) |
Entity Type: | Individual |
Prefix: | DR |
First Name: | PREMNATH |
Middle Name: | |
Last Name: | NARAHARI |
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: | 601 MEMORY LN |
Mailing Address - Street 2: | |
Mailing Address - City: | YORK |
Mailing Address - State: | PA |
Mailing Address - Zip Code: | 17402-2231 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 717-851-1405 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 954 ISABEL DR |
Practice Address - Street 2: | |
Practice Address - City: | LEBANON |
Practice Address - State: | PA |
Practice Address - Zip Code: | 17042-7482 |
Practice Address - Country: | US |
Practice Address - Phone: | 717-376-1180 |
Practice Address - Fax: | 717-273-6937 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2006-03-10 |
Last Update Date: | 2024-04-15 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
PA | MD041165E | 207RG0100X |
FL | ME126403 | 207RG0100X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207RG0100X | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
PA | 532504 | Other | BLUE SHIELD |
FL | 017525100 | Medicaid | |
FL | 34FI5 | Other | BCBS |
PA | 0011522680002 | Medicaid | |
PA | 532504 | Other | BLUE SHIELD |
PA | 0011522680002 | Medicaid | |
FL | 017525100 | Medicaid |