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General NPI Number Information
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NPI Number | 1902064140
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Entity Type | Individual
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Provider Name | HARISH KAKKILAYA M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/23/2008
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Last Update Date | 07/09/2025
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Provider Practice Location Address
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Address Line | 500 BERLIN CROSS KEYS RD
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City | SICKLERVILLE
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State | NJ
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Zip | 08081
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Country | US
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Telephone | 856-673-4500
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Fax |
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Provider Business Mailing Address
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Address Line | 1 FEDERAL ST # 200
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City | CAMDEN
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State | NJ
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Zip | 08103-1088
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Country | US
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Telephone | 856-356-4924
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | C1-0011498
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License Number State | DE
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | D0067469
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License Number State | MD
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Taxonomy #3
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 25MA08543800
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License Number State | NJ
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