Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RI0200X | Infectious Disease | 9500993 | NC |
Y | 207RI0200X | Infectious Disease | MD61064980 | WA |
NPI | 1073500765 |
---|---|
Provider Name | Dr. Harish Marisiddaiah |
First Address | Gastonia, NC 28054-4725 |
Second Address | Gastonia, NC 28054-7491 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/09/2005 |
Last Update Date | 03/09/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8954784 | (05) | NC |
G16623 | (02) | NC |
N00993 | (05) | SC |