Provider Demographics
NPI:1326141797
Name:HARRISON, DAVID CUSHMAN (MD)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:CUSHMAN
Last Name:HARRISON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4807 HERMITAGE RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23227-3335
Mailing Address - Country:US
Mailing Address - Phone:804-262-7888
Mailing Address - Fax:804-262-3646
Practice Address - Street 1:4807 HERMITAGE RD
Practice Address - Street 2:SUITE 102
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23227-3335
Practice Address - Country:US
Practice Address - Phone:804-262-7888
Practice Address - Fax:804-262-3646
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101056283207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA227923OtherANTHEM
VA118026OtherSOUTHERN HEALTH
VA227923OtherANTHEM