Provider Demographics
NPI:1942260427
Name:PATHI, HARI P (MD)
Entity Type:Individual
Prefix:
First Name:HARI
Middle Name:P
Last Name:PATHI
Suffix:
Gender:M
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 3360
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208-3360
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:914 S. SCHEUBER ROAD
Practice Address - Street 2:PMG SW WA PCH HOSPITALISTS
Practice Address - City:CENTRALIA
Practice Address - State:WA
Practice Address - Zip Code:98531
Practice Address - Country:US
Practice Address - Phone:360-330-8976
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-27
Last Update Date:2017-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60702574207R00000X
IL036.118493208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILCA2264OtherRR GROUP
ILP00393190OtherRR MEDICARE
IL036118493Medicaid
WI0043Medicare ID - Type Unspecified
WII02515Medicare UPIN
ILK38224Medicare ID - Type UnspecifiedINDIVIDUAL #
WI34830900Medicaid
IL214881OtherMEDICARE GROUP PTAN
IL833120Medicare ID - Type UnspecifiedGROUP #