Provider Demographics
NPI:1144214883
Name:HARRISON, WALTER DOUGLAS (MD)
Entity Type:Individual
Prefix:
First Name:WALTER
Middle Name:DOUGLAS
Last Name:HARRISON
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 7200
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27804-0200
Mailing Address - Country:US
Mailing Address - Phone:252-937-0200
Mailing Address - Fax:252-451-0056
Practice Address - Street 1:250 NASH MEDICAL ARTS MALL
Practice Address - Street 2:SUITE A
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27804
Practice Address - Country:US
Practice Address - Phone:252-937-0227
Practice Address - Fax:252-937-3105
Is Sole Proprietor?:No
Enumeration Date:2005-09-08
Last Update Date:2015-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC34343208600000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC10456OtherBCBSNC
NC42423OtherMEDCOST
NC6109936OtherCIGNA HEALTHCARE
NC20024902OtherRAILROAD MEDICARE
NC8940156Medicaid
NC10456OtherBCBSNC
NC42423OtherMEDCOST