Provider Demographics
NPI:1083784359
Name:DAVID L HARRIS MD LTD
Entity Type:Organization
Organization Name:DAVID L HARRIS MD LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:LEA
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:OFFICE PROPRIETOR MD
Authorized Official - Phone:804-435-1661
Mailing Address - Street 1:PO BOX 1449
Mailing Address - Street 2:95 HARRIS DR
Mailing Address - City:KILMARNOCK
Mailing Address - State:VA
Mailing Address - Zip Code:22482-1449
Mailing Address - Country:US
Mailing Address - Phone:804-435-1661
Mailing Address - Fax:804-435-0117
Practice Address - Street 1:95 HARRIS DR
Practice Address - Street 2:BUILDING 3
Practice Address - City:KILMARNOCK
Practice Address - State:VA
Practice Address - Zip Code:22482
Practice Address - Country:US
Practice Address - Phone:804-435-1661
Practice Address - Fax:804-435-0117
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101023906208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA7572611Medicaid
B08064Medicare UPIN
VA7572611Medicaid
341936701Medicare ID - Type Unspecified