Provider Demographics
NPI:1326206749
Name:HARMAN, DEREK C (DO)
Entity Type:Individual
Prefix:
First Name:DEREK
Middle Name:C
Last Name:HARMAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2713 COUNTRY CLUB RD
Mailing Address - Street 2:
Mailing Address - City:BIG STONE GAP
Mailing Address - State:VA
Mailing Address - Zip Code:24219-4145
Mailing Address - Country:US
Mailing Address - Phone:276-533-3193
Mailing Address - Fax:
Practice Address - Street 1:106 SPRING AVE NE
Practice Address - Street 2:
Practice Address - City:WISE
Practice Address - State:VA
Practice Address - Zip Code:24293
Practice Address - Country:US
Practice Address - Phone:276-533-3193
Practice Address - Fax:276-533-3197
Is Sole Proprietor?:No
Enumeration Date:2008-06-02
Last Update Date:2020-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102203090207Q00000X
WV2785207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAVV58888B288Medicare PIN