Provider Demographics
NPI:1245308931
Name:VITTAL, HARSHA (MD)
Entity type:Individual
Prefix:DR
First Name:HARSHA
Middle Name:
Last Name:VITTAL
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 1:325 DISTEL CIR STE 107
Mailing Address - Street 2:
Mailing Address - City:LOS ALTOS
Mailing Address - State:CA
Mailing Address - Zip Code:94022-1408
Mailing Address - Country:US
Mailing Address - Phone:408-523-3000
Mailing Address - Fax:
Practice Address - Street 1:150 N JACKSON AVE
Practice Address - Street 2:SUITE 107
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95116-1908
Practice Address - Country:US
Practice Address - Phone:408-926-2182
Practice Address - Fax:408-926-8370
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA95303207RG0100X, 207R00000X, 207RG0100X
MEEC-06-1094207RG0100X
NV10251207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine