Provider Demographics
NPI:1699773457
Name:DULAMAL, HARRESH BHAGWANDAS (MD)
Entity type:Individual
Prefix:DR
First Name:HARRESH
Middle Name:BHAGWANDAS
Last Name:DULAMAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:HARRESH
Other - Middle Name:BHAGWANDAS
Other - Last Name:DULAMAL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:9 CHATHAM CTR S
Mailing Address - Street 2:SUITE C
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-7456
Mailing Address - Country:US
Mailing Address - Phone:912-527-7211
Mailing Address - Fax:912-527-7222
Practice Address - Street 1:9 CHATHAM CTR S
Practice Address - Street 2:SUITE C
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-7456
Practice Address - Country:US
Practice Address - Phone:912-527-7211
Practice Address - Fax:912-527-7222
Is Sole Proprietor?:No
Enumeration Date:2005-07-14
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA038474207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA681676OtherBLUECROSS BLUESHIELD
GA000612048CMedicaid
SCG38474Medicaid
GA080088386OtherRR MEDICARE
GA080088386OtherRR MEDICARE
GA681676OtherBLUECROSS BLUESHIELD