Provider Demographics
NPI:1063499069
Name:CHARLOTTE J. HARRIS, MD, PSC
Entity Type:Organization
Organization Name:CHARLOTTE J. HARRIS, MD, PSC
Other - Org Name:ORTHOPEDIC ASSOCIATES OF MAYSVILLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLOTTE
Authorized Official - Middle Name:J
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:606-759-9729
Mailing Address - Street 1:991 MEDICAL PARK DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:MAYSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41056-8764
Mailing Address - Country:US
Mailing Address - Phone:606-759-9729
Mailing Address - Fax:606-759-0602
Practice Address - Street 1:991 MEDICAL PARK DR
Practice Address - Street 2:SUITE 300
Practice Address - City:MAYSVILLE
Practice Address - State:KY
Practice Address - Zip Code:41056-8764
Practice Address - Country:US
Practice Address - Phone:606-759-9729
Practice Address - Fax:606-759-0602
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-30
Last Update Date:2010-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY26277207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY65904427Medicaid
KY6730Medicare ID - Type UnspecifiedGROUP #