Provider Demographics
NPI:1770520199
Name:HARISH, VALLATHUCHERRY CHAKALAKUMBIL (MD)
Entity type:Individual
Prefix:
First Name:VALLATHUCHERRY
Middle Name:CHAKALAKUMBIL
Last Name:HARISH
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 1:624 QUAKER LN
Mailing Address - Street 2:STE. 207C
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27262-3832
Mailing Address - Country:US
Mailing Address - Phone:336-883-2500
Mailing Address - Fax:
Practice Address - Street 1:302 WESTWOOD AVE
Practice Address - Street 2:
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27262-4324
Practice Address - Country:US
Practice Address - Phone:336-781-4080
Practice Address - Fax:336-781-4081
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2016-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200300155207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5903850Medicaid
G79311Medicare UPIN
NCNCF716BMedicare PIN