Provider Demographics
NPI:1003880345
Name:HARRISON, HOWARD COURTENAY SR (MD)
Entity Type:Individual
Prefix:
First Name:HOWARD
Middle Name:COURTENAY
Last Name:HARRISON
Suffix:SR
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:PO BOX 7068
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23707-0068
Mailing Address - Country:US
Mailing Address - Phone:757-686-3542
Mailing Address - Fax:757-686-0230
Practice Address - Street 1:1101 FIRST COLONIAL RD
Practice Address - Street 2:SUITE 101
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23454-2409
Practice Address - Country:US
Practice Address - Phone:757-496-9020
Practice Address - Fax:757-481-0638
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101017780207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA461501OtherANTHEM
VA37156OtherSENTARA/OPTIMA
VA000580B28Medicare ID - Type Unspecified
VAE06925Medicare UPIN