Provider Demographics
NPI:1265403950
Name:DHANDHA, MEDHAVINI HARKISAN (MD)
Entity type:Individual
Prefix:
First Name:MEDHAVINI
Middle Name:HARKISAN
Last Name:DHANDHA
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 25756
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28314
Mailing Address - Country:US
Mailing Address - Phone:910-437-9600
Mailing Address - Fax:910-437-9801
Practice Address - Street 1:3415B MELROSE ROAD
Practice Address - Street 2:PRIME PEDIATRICS
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304
Practice Address - Country:US
Practice Address - Phone:910-437-9600
Practice Address - Fax:910-437-9801
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9401399208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7928785Medicaid
NC7928785Medicaid