EXCLUDEDPROVIDER
Individual Revocation

Tirtandharyana Haryadi

Tonawanda, NY 14150

Public HHS-OIG LEIE exclusion record

The HHS-OIG List of Excluded Individuals/Entities (LEIE) file imported by ExcludedProvider.com on October 4, 2026 contains a record for Tirtandharyana Haryadi of Tonawanda, NY with exclusion type 1128b4, which HHS-OIG's list of exclusion authorities describes as “license revocation, suspension, or surrender”, and an exclusion date of February 11, 1991. This page is not an official HHS-OIG record, and a matching name alone does not show that the record refers to a particular person; confirm identity and current status with HHS-OIG.

Status
Listed in the LEIE file imported October 4, 2026
Record type
Individual
Location
Tonawanda, NY 14150
Exclusion date
February 11, 1991
Exclusion type
Revocation (1128b4)
LEIE file imported
October 4, 2026

Record summary

Tirtandharyana Haryadi appears in the HHS-OIG List of Excluded Individuals/Entities (LEIE) public dataset as an individual record associated with Tonawanda, New York. The exclusion date shown in the source record is February 11, 1991. The exclusion type is 1128b4, identified by HHS-OIG as license revocation, suspension, or surrender.

Source record

SourceHHS-OIG LEIE downloadable file (UPDATED.csv)
Record typeIndividual
Status in imported filesListed in the LEIE file imported October 4, 2026
Exclusion dateFebruary 11, 1991
Exclusion typeLicense revocation, suspension, or surrender (1128b4)
UPIN (as listed in LEIE)B36059
LEIE file importedOctober 4, 2026
File timestampSeptember 10, 2026 (Last-Modified header from the HHS-OIG download server; not an official release date)
HHS-OIG release dateNot independently verified

What this exclusion type means

HHS-OIG identifies exclusion type 1128b4 as “License revocation, suspension, or surrender.” License revocation, suspension, or surrender (permissive exclusion).

This exclusion type is a statutory category used by HHS-OIG in the LEIE dataset. The category describes the legal authority associated with the exclusion record, not a separate investigation or additional reporting by Excluded Provider.

Location and provider classification

This LEIE record is associated with Tonawanda, NY 14150. The listed provider category is Medical Practice, MD. The listed specialty is General Practice / FP.

Other excluded providers in Tonawanda, NY

Other individuals and entities in the latest imported HHS-OIG LEIE file with a Tonawanda, NY address.

William Henry III Stephan Individual Felony Fraud
Tonawanda, NY · Felony conviction relating to health care fraud · Exclusion date May 20, 2026
Nancy Marie Walsh Individual Revocation
Tonawanda, NY · License revocation, suspension, or surrender · Exclusion date Jul 19, 2007
Mark D Brice Individual Patient Abuse
Tonawanda, NY · Conviction relating to patient abuse or neglect · Exclusion date Aug 20, 2003
Mary Tisby Individual Revocation
Tonawanda, NY · License revocation, suspension, or surrender · Exclusion date Nov 20, 2000

How to verify this record

This page is a public-record summary and should be treated as a possible LEIE match, not final identity verification. To verify the record, use the official HHS-OIG LEIE search and compare available identifying information through the official process. Name, location, provider category, specialty, exclusion date, and NPI should be treated as matching clues rather than final proof of identity.

What this page does not include

This page summarizes the HHS-OIG LEIE public dataset only. It does not search state Medicaid exclusion lists, state licensing-board actions, court records, malpractice records, employment history, civil lawsuits, or non-public investigations.

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