Provider Demographics
NPI:1699977744
Name:HARISARAN, VINCENT M (MD)
Entity type:Individual
Prefix:
First Name:VINCENT
Middle Name:M
Last Name:HARISARAN
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 1:450 VETERANS MEMORIAL PKWY
Mailing Address - Street 2:BLDG 14
Mailing Address - City:EAST PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02914-5300
Mailing Address - Country:US
Mailing Address - Phone:401-435-8488
Mailing Address - Fax:401-435-6694
Practice Address - Street 1:450 VETERANS MEMORIAL PKWY
Practice Address - Street 2:BLDG 14
Practice Address - City:EAST PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02914-5300
Practice Address - Country:US
Practice Address - Phone:401-435-8488
Practice Address - Fax:401-435-6694
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-01
Last Update Date:2013-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RILP01080208600000X
RICMD14133208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
No208600000XAllopathic & Osteopathic PhysiciansSurgery