Provider Demographics
NPI:1851334163
Name:HARMON, REVELLA BENDU (MD)
Entity Type:Individual
Prefix:DR
First Name:REVELLA
Middle Name:BENDU
Last Name:HARMON
Suffix:
Gender:F
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:PO BOX 602195
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-2195
Mailing Address - Country:US
Mailing Address - Phone:919-350-0351
Mailing Address - Fax:919-350-7687
Practice Address - Street 1:901 OLD KNIGHT RD
Practice Address - Street 2:
Practice Address - City:KNIGHTDALE
Practice Address - State:NC
Practice Address - Zip Code:27545-9065
Practice Address - Country:US
Practice Address - Phone:919-266-6211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-14
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200000065207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCB1393OtherMEDCOST
202242698OtherTRICARE
NC2384012OtherUNITED HEALTH CARE
NC127JUOtherBLUE CROSS BLUE SHIELD
NC1851334163Medicaid
G94578Medicare UPIN
NC89127JUMedicaid