Healthcare Provider Details

I. General information

NPI: 1821534777
Provider Name (Legal Business Name): HARI GNANASEKERAM, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2017
Last Update Date: 01/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8720 EMGE RD
BALTIMORE MD
21234-3504
US

IV. Provider business mailing address

8720 EMGE RD
BALTIMORE MD
21234-3504
US

V. Phone/Fax

Practice location:
  • Phone: 732-280-6000
  • Fax:
Mailing address:
  • Phone: 732-280-6000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207RB0002X
TaxonomyObesity Medicine (Internal Medicine) Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: THOMAS J CORNEY
Title or Position: MANAGER
Credential:
Phone: 732-280-6000