Provider Demographics
NPI:1225060205
Name:HARRIS, BRENT T (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:BRENT
Middle Name:T
Last Name:HARRIS
Suffix:
Gender:M
Credentials:MD, PHD
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 631872
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21263-1872
Mailing Address - Country:US
Mailing Address - Phone:202-687-5345
Mailing Address - Fax:202-687-8935
Practice Address - Street 1:3800 RESERVOIR RD NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20007-2113
Practice Address - Country:US
Practice Address - Phone:202-687-5345
Practice Address - Fax:202-687-8935
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD039072207ZN0500X, 207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
No207ZN0500XAllopathic & Osteopathic PhysiciansPathologyNeuropathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30203304Medicaid
VT1009229Medicaid
NH30203304Medicaid
DC213547YTFMedicare PIN
NHG93901Medicare UPIN