Provider Demographics
NPI:1164424123
Name:HARRISON, JOAN (MD)
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:
Last Name:HARRISON
Suffix:
Gender:F
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 1070
Mailing Address - Street 2:
Mailing Address - City:FALL RIVER
Mailing Address - State:MA
Mailing Address - Zip Code:02722-1070
Mailing Address - Country:US
Mailing Address - Phone:508-676-3292
Mailing Address - Fax:508-672-7181
Practice Address - Street 1:546 MAIN RD
Practice Address - Street 2:PRIMA CARE, PC
Practice Address - City:TIVERTON
Practice Address - State:RI
Practice Address - Zip Code:02878-1350
Practice Address - Country:US
Practice Address - Phone:401-624-8200
Practice Address - Fax:401-624-8345
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-02
Last Update Date:2016-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA82181207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAF70853Medicare UPIN
RI007010235Medicare PIN
MAA31876Medicare PIN