Provider Demographics
NPI:1023007283
Name:HARRIS, SCOTT M (MD)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:M
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 1:25 COMMUNICATION WAY
Mailing Address - Street 2:MEDICAL AFFILIATES OF CAPE COD
Mailing Address - City:HYANNIS
Mailing Address - State:MA
Mailing Address - Zip Code:02601
Mailing Address - Country:US
Mailing Address - Phone:508-957-8669
Mailing Address - Fax:508-957-8678
Practice Address - Street 1:ONE TROWBRIDGE ROAD
Practice Address - Street 2:
Practice Address - City:BOURNE
Practice Address - State:MA
Practice Address - Zip Code:02532
Practice Address - Country:US
Practice Address - Phone:508-759-9200
Practice Address - Fax:508-743-0740
Is Sole Proprietor?:No
Enumeration Date:2005-10-19
Last Update Date:2010-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA44375174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3015017Medicaid
MAJ03208OtherBCBS
MA044375OtherTUFTS
MA17016OtherHPHC
B74403Medicare UPIN
MA044375OtherTUFTS