Provider Demographics
NPI:1003820523
Name:HARRIS, DAVID LEA (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:LEA
Last Name:HARRIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:PO BOX 1449
Mailing Address - Street 2:95 HARRIS DR
Mailing Address - City:KILMARNOCK
Mailing Address - State:VA
Mailing Address - Zip Code:22482-1449
Mailing Address - Country:US
Mailing Address - Phone:804-435-1661
Mailing Address - Fax:804-435-0117
Practice Address - Street 1:95 HARRIS DRIVE
Practice Address - Street 2:
Practice Address - City:KILMARNOCK
Practice Address - State:VA
Practice Address - Zip Code:22482
Practice Address - Country:US
Practice Address - Phone:804-435-1661
Practice Address - Fax:804-435-0117
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101023906208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA7572611Medicaid
B08064Medicare UPIN