Provider Demographics
NPI:1710274360
Name:HARBOR INTERNAL MEDICINE PLLC
Entity Type:Organization
Organization Name:HARBOR INTERNAL MEDICINE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:DEVINA
Authorized Official - Middle Name:
Authorized Official - Last Name:TALWAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:585-230-0186
Mailing Address - Street 1:478 WILLIAMSON RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-8192
Mailing Address - Country:US
Mailing Address - Phone:585-230-0186
Mailing Address - Fax:
Practice Address - Street 1:478 WILLIAMSON RD
Practice Address - Street 2:SUITE B
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-8192
Practice Address - Country:US
Practice Address - Phone:585-230-0186
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-04
Last Update Date:2011-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200901402261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty