Provider Demographics
NPI:1003898826
Name:HARRIS, MARCIA A (MD)
Entity Type:Individual
Prefix:DR
First Name:MARCIA
Middle Name:A
Last Name:HARRIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:714 COLES KNOB RD NE
Mailing Address - Street 2:
Mailing Address - City:PILOT
Mailing Address - State:VA
Mailing Address - Zip Code:24138-1329
Mailing Address - Country:US
Mailing Address - Phone:540-651-6440
Mailing Address - Fax:
Practice Address - Street 1:434 PEPPERS FERRY RD NW
Practice Address - Street 2:
Practice Address - City:CHRISTIANSBURG
Practice Address - State:VA
Practice Address - Zip Code:24073-5780
Practice Address - Country:US
Practice Address - Phone:540-382-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-17
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101-057628207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA005605369Medicaid
VA000235C86Medicare ID - Type Unspecified
VAG72790Medicare UPIN