Healthcare Provider Details

I. General information

NPI: 1144574682
Provider Name (Legal Business Name): NANJUNDAPPA SOMASEKHAR HARSHAVARDHANA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2012
Last Update Date: 11/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34TH STREET AND CIVIC CENTER BOULVEVARD 2ND FLOOR, WOOD BUILDING - DIVISION OF ORTHOPEDICS
PHILADELPHIA PA
19104
US

IV. Provider business mailing address

4701 PINE ST APT M9, GARDEN COURT PLAZA
PHILADELPHIA PA
19143-1816
US

V. Phone/Fax

Practice location:
  • Phone: 215-590-1534
  • Fax:
Mailing address:
  • Phone: 215-436-7730
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XP3100X
TaxonomyPediatric Orthopaedic Surgery Physician
License NumberMT202987
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: