Provider Demographics
NPI:1053366344
Name:HARANATH, SAI PRAVEEN (MBBS)
Entity type:Individual
Prefix:
First Name:SAI PRAVEEN
Middle Name:
Last Name:HARANATH
Suffix:
Gender:M
Credentials:MBBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4A RD 10 C MLA MP COLONY
Mailing Address - Street 2:JUBILEE HILLS
Mailing Address - City:HYDERABAD
Mailing Address - State:TELANGANA
Mailing Address - Zip Code:500033
Mailing Address - Country:IN
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1425 S MAIN ST
Practice Address - Street 2:THE PERMANENTE MEDICAL GROUP, DEPARTMENT OF PULMONOLOGY
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94596-5318
Practice Address - Country:US
Practice Address - Phone:925-295-4050
Practice Address - Fax:925-295-6488
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2022-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA84840207R00000X, 207RP1001X, 207RC0200X, 207R00000X, 207RC0200X
ORMD25179207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR233187Medicaid
OR134105Medicare ID - Type Unspecified
OR233187Medicaid