Provider Demographics
NPI:1851353403
Name:HARITHA, CHANDRA P (MD)
Entity Type:Individual
Prefix:DR
First Name:CHANDRA
Middle Name:P
Last Name:HARITHA
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 1:2201 ARLINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:BESSEMER
Mailing Address - State:AL
Mailing Address - Zip Code:35020-4221
Mailing Address - Country:US
Mailing Address - Phone:205-424-6001
Mailing Address - Fax:205-497-9369
Practice Address - Street 1:2201 ARLINGTON AVE
Practice Address - Street 2:
Practice Address - City:BESSEMER
Practice Address - State:AL
Practice Address - Zip Code:35020-4221
Practice Address - Country:US
Practice Address - Phone:205-424-6001
Practice Address - Fax:205-497-9369
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2011-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00018045207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051099102OtherBLUE SHIELD
AL303729301Medicaid
ALG588OtherMEDICARE GROUP NUMBER
AL303769301Medicaid
AL051099106OtherBLUE SHIELD
AL303749301Medicaid
ALG586OtherMEDICARE GROUP NUMBER
AL051099101OtherBLUE SHIELD
AL303739301Medicaid
AL051099104OtherBLUE SHIELD
AL051099105OtherBLUE SHIELD
AL303709301Medicaid
AL303719301Medicaid
ALD074OtherMEDICARE GROUP NUMBER
ALG590OtherMEDICARE GROUP NUMBER
ALG591OtherMEDICARE GROUP NUMBER
ALG592OtherMEDICARE GROUP NUMBER
AL051055328OtherBLUE SHIELD
ALG587OtherMEDICARE GROUP NUMBER
AL051028060OtherBLUE SHIELD
AL303799301Medicaid
AL000028060Medicare ID - Type Unspecified
AL303719301Medicaid
AL051099104OtherBLUE SHIELD
ALD074OtherMEDICARE GROUP NUMBER