Individual
SRI HARSHA TELLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MBBS
Contact information
Practice address
520 S EAGLE RD, MERIDIAN, ID 83642-6351
(208) 706-5651
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241
Taxonomy
Speciality
Code
Description
License number
State
207RH0003X
Hematology & Oncology Physician
Primary
M-17185
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
405065
—
SC
Enumeration date
07/02/2012
Last updated
12/18/2024
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