Provider Demographics
NPI:1023001625
Name:HARRIS, MATTHEW SCOTT (MD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:SCOTT
Last Name:HARRIS
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:PO BOX 418283
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-8283
Mailing Address - Country:US
Mailing Address - Phone:703-558-1544
Mailing Address - Fax:
Practice Address - Street 1:3800 RESERVOIR RD NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20007-2113
Practice Address - Country:US
Practice Address - Phone:202-444-3001
Practice Address - Fax:202-444-1462
Is Sole Proprietor?:No
Enumeration Date:2005-08-30
Last Update Date:2012-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35081929H174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2529535Medicaid
OH000000349232OtherANTHEM PIN
OH341827025OtherTAX ID #
OH341827025OtherTAX ID #
OH2529535Medicaid
DC018996M65Medicare PIN