Provider Demographics
NPI:1144216763
Name:HARRIS, MALCOLM S (MD)
Entity Type:Individual
Prefix:DR
First Name:MALCOLM
Middle Name:S
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 1:1099 NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:MILLVALE
Mailing Address - State:PA
Mailing Address - Zip Code:15209-2247
Mailing Address - Country:US
Mailing Address - Phone:412-821-4443
Mailing Address - Fax:412-821-2295
Practice Address - Street 1:1099 NORTH AVE
Practice Address - Street 2:
Practice Address - City:MILLVALE
Practice Address - State:PA
Practice Address - Zip Code:15209-2247
Practice Address - Country:US
Practice Address - Phone:412-821-4443
Practice Address - Fax:412-821-2295
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD019452E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101325504-0001Medicaid
PA575948R9SMedicare ID - Type Unspecified
PA101325504-0001Medicaid