Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0300X | Geriatric Medicine | C1-0005962 | DE |
NPI | 1164441242 |
---|---|
Provider Name | Dr. Harsha Tankala |
First Address | Dover, DE 19904-5586 |
Second Address | Dover, DE 19904-3483 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2006 |
Last Update Date | 01/07/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0001058401 | (05) | DE |
H29530 | (02) |