Provider Demographics
NPI:1003805359
Name:HARRY, PHILIP S (MD)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:S
Last Name:HARRY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 PARK HILL DR
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22401-3377
Mailing Address - Country:US
Mailing Address - Phone:540-372-6737
Mailing Address - Fax:540-372-3510
Practice Address - Street 1:501 PARK HILL DR
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-3377
Practice Address - Country:US
Practice Address - Phone:540-372-6737
Practice Address - Fax:540-372-3510
Is Sole Proprietor?:No
Enumeration Date:2005-10-19
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101840374207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA6402135Medicaid
VA6402135Medicaid
00V611C40Medicare PIN