Provider Demographics
NPI:1295844959
Name:HARRIS, ROBERT MARK (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:MARK
Last Name:HARRIS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2260 S CHURCH ST STE 303
Mailing Address - Street 2:GREATER BURLINGTON MENTAL HEALTH SERVICES, EASTER SEALS
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27215-5389
Mailing Address - Country:US
Mailing Address - Phone:336-585-1737
Mailing Address - Fax:336-585-9540
Practice Address - Street 1:2260 S CHURCH ST STE 303
Practice Address - Street 2:GREATER BURLINGTON MENTAL HEALTH SERVICES, EASTER SEALS
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27215-5389
Practice Address - Country:US
Practice Address - Phone:336-585-1737
Practice Address - Fax:336-585-9540
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2011-08-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC217902084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89137YGMedicaid
NC89137YGMedicaid
207060DMedicare ID - Type Unspecified