Provider Demographics
NPI:1770883191
Name:BELLAM, HARITHA (MD,)
Entity type:Individual
Prefix:
First Name:HARITHA
Middle Name:
Last Name:BELLAM
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 1:4214 ANDREWS HWY STE 240
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79703-4817
Mailing Address - Country:US
Mailing Address - Phone:432-221-5960
Mailing Address - Fax:432-221-5981
Practice Address - Street 1:5615 DEAUVILLE STE 240
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79706-2709
Practice Address - Country:US
Practice Address - Phone:432-221-5560
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-01
Last Update Date:2023-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01069674A207R00000X
IL036.126660390200000X
TXP7070207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201037390Medicaid
TX415412YPVDOtherTX MEDICARE - PREMIER
IN000000734012OtherANTHEM