Provider Demographics
NPI:1447506712
Name:DHARMAVARAM HARIRAO, NAGACHANDRA KIRAN (MD)
Entity type:Individual
Prefix:MR
First Name:NAGACHANDRA
Middle Name:KIRAN
Last Name:DHARMAVARAM HARIRAO
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1400 SOUTH DOBSON ROAD
Mailing Address - Street 2:ATTN: BMG HOSPITALIST TEAM/AMANDA GUMP
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85202
Mailing Address - Country:US
Mailing Address - Phone:480-412-6788
Mailing Address - Fax:480-412-6848
Practice Address - Street 1:1400 SOUTH DOBSON ROAD
Practice Address - Street 2:ATTN: BMG HOSPITALIST TEAM/AMANDA GUMP
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85202
Practice Address - Country:US
Practice Address - Phone:480-412-6788
Practice Address - Fax:480-412-6848
Is Sole Proprietor?:No
Enumeration Date:2012-07-24
Last Update Date:2021-02-18
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Provider Licenses
StateLicense IDTaxonomies
MI4301099995207R00000X
AZ50070207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ172092Medicaid
AZ172092Medicaid