Provider Demographics
NPI:1851328553
Name:HARP, GRADY (MD)
Entity Type:Individual
Prefix:DR
First Name:GRADY
Middle Name:
Last Name:HARP
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:GRADY
Other - Middle Name:E
Other - Last Name:HARP, MD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:414 N CAMDEN DR
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-4532
Mailing Address - Country:US
Mailing Address - Phone:310-275-5079
Mailing Address - Fax:310-275-5079
Practice Address - Street 1:414 N CAMDEN DR
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-4532
Practice Address - Country:US
Practice Address - Phone:310-275-5079
Practice Address - Fax:310-275-5079
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-27
Last Update Date:2012-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG15160208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG155160Medicare ID - Type UnspecifiedPROVIDER NUMBER