Provider Demographics
NPI:1063446425
Name:HARANATH, SAI PRASHANTH (MD)
Entity type:Individual
Prefix:MR
First Name:SAI PRASHANTH
Middle Name:
Last Name:HARANATH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1955 W BASELINE RD STE 113-647
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85202-9003
Mailing Address - Country:US
Mailing Address - Phone:480-626-4813
Mailing Address - Fax:480-445-9238
Practice Address - Street 1:1400 S DOBSON ROAD
Practice Address - Street 2:ATTN AMANDA GUMP/ HOSPITALISTS
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85202-4707
Practice Address - Country:US
Practice Address - Phone:480-543-2034
Practice Address - Fax:480-543-2647
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN45225207R00000X
AZ60939208M00000X, 207R00000X
TXN8517207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX282280102Medicaid
TX282280103Medicaid
TX282280104Medicaid
TX282280101Medicaid
TXTXB132521Medicare PIN
TXTXB131369Medicare PIN
TX282280103Medicaid
TXP01149341Medicare PIN
TXP00989759Medicare PIN
TX282280102Medicaid
TX329619YNJCMedicare PIN
TXTXB156049Medicare PIN