Provider Demographics
NPI:1114927498
Name:HARRIS, ERIN S (DO)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:S
Last Name:HARRIS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 S PLUM ST
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43040-1630
Mailing Address - Country:US
Mailing Address - Phone:937-644-1920
Mailing Address - Fax:937-644-2024
Practice Address - Street 1:610 S PLUM ST
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43040-1630
Practice Address - Country:US
Practice Address - Phone:937-644-1920
Practice Address - Fax:937-644-2024
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34-007191208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2249016Medicaid
OH2249016Medicaid