Provider Demographics
NPI:1790786036
Name:HEDA, HARIKISAN RAMBILAS (MD)
Entity Type:Individual
Prefix:DR
First Name:HARIKISAN
Middle Name:RAMBILAS
Last Name:HEDA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:H.
Other - Middle Name:R
Other - Last Name:HEDA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:614 EASTERN SHORE DR
Mailing Address - Street 2:SUITE D
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21804-5955
Mailing Address - Country:US
Mailing Address - Phone:410-749-5419
Mailing Address - Fax:410-749-1047
Practice Address - Street 1:614 EASTERN SHORE DR
Practice Address - Street 2:SUITE D
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21804-5955
Practice Address - Country:US
Practice Address - Phone:410-749-5419
Practice Address - Fax:410-749-1047
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2015-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD25036174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDD01248Medicare UPIN