Provider Demographics
NPI:1255692414
Name:SEN, HARSHA A (MD)
Entity type:Individual
Prefix:DR
First Name:HARSHA
Middle Name:A
Last Name:SEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2800 ROSS CLARK CIR
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36301-2040
Mailing Address - Country:US
Mailing Address - Phone:859-264-0445
Mailing Address - Fax:
Practice Address - Street 1:2800 ROSS CLARK CIR
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36301-2040
Practice Address - Country:US
Practice Address - Phone:334-793-2211
Practice Address - Fax:334-793-7161
Is Sole Proprietor?:No
Enumeration Date:2012-06-05
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC31952207W00000X
VA0101041515207W00000X
KY29974207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL102I186010OtherMEDICARE PTAN
KYK054760Medicare UPIN