Provider Demographics
NPI:1003266131
Name:HARRIS, ALLEN RUSSELL (DO)
Entity Type:Individual
Prefix:
First Name:ALLEN
Middle Name:RUSSELL
Last Name:HARRIS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 305
Mailing Address - Street 2:
Mailing Address - City:NARBERTH
Mailing Address - State:PA
Mailing Address - Zip Code:19072-0305
Mailing Address - Country:US
Mailing Address - Phone:610-601-9177
Mailing Address - Fax:610-601-9168
Practice Address - Street 1:3537 W CHESTER PIKE
Practice Address - Street 2:
Practice Address - City:NEWTOWN SQUARE
Practice Address - State:PA
Practice Address - Zip Code:19073-3701
Practice Address - Country:US
Practice Address - Phone:610-601-9177
Practice Address - Fax:610-016-9168
Is Sole Proprietor?:No
Enumeration Date:2016-06-20
Last Update Date:2020-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOT017181207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine