Provider Demographics
NPI:1235115049
Name:HARRIS, SAMUEL R (MD)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:R
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 1:7 MEDICAL PARK DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27292-6768
Mailing Address - Country:US
Mailing Address - Phone:336-243-2431
Mailing Address - Fax:336-243-2359
Practice Address - Street 1:7 MEDICAL PARK DR
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:NC
Practice Address - Zip Code:27292-6768
Practice Address - Country:US
Practice Address - Phone:336-243-2431
Practice Address - Fax:336-243-2359
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2012-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC15934207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2180458OtherAETNA - HMO
NC8940008Medicaid
NC486OtherPARTNERS MEDICARE CHOICE
NC160049975OtherRAILROAD MEDICARE
NC291926OtherMAMSI
NC2140776001OtherCIGNA HEALTHCARE
NC25042OtherMEDCOST
NC40008OtherBCBS
NC4098797OtherAETNA - PPO
NC0701183OtherUNITED HEALTHCARE
NC151097OtherWELLPATH/ COVENTRY
NC25042OtherMEDCOST