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General NPI Number Information
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NPI Number | 1770520199
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Entity Type | Individual
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Provider Name | VALLATHUCHERRY CHAKALAKUMBIL HARISH MD
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Gender | Male
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Dates
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Enumeration Date | 06/02/2006
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Last Update Date | 10/04/2016
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Provider Practice Location Address
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Address Line | 302 WESTWOOD AVE
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City | HIGH POINT
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State | NC
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Zip | 27262-4324
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Country | US
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Telephone | 336-781-4080
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Fax | 336-781-4081
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Provider Business Mailing Address
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Address Line | 624 QUAKER LN STE. 207C
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City | HIGH POINT
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State | NC
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Zip | 27262-3832
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Country | US
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Telephone | 336-883-2500
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number | 200300155
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License Number State | NC
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