Organization
LIFESPAN MEDICAL SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
HARSHA TANKALA M.D. (OWNER/PRESIDENT)
(302) 678-0950
Entity
Organization
Contact information
Practice address
1125 FORREST AVE, DOVER, DE 19904-3483
(302) 346-0100
(302) 346-0103
Mailing address
1125 FORREST AVE, DOVER, DE 19904-3483
(302) 346-0100
(302) 346-0103
Taxonomy
Speciality
Code
Description
License number
State
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
Primary
C1-0005962
DE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1000041898
—
DE
Enumeration date
10/23/2006
Last updated
06/21/2018
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