Provider Demographics
NPI:1366638769
Name:HARRIS, ROGER M (MD)
Entity Type:Individual
Prefix:DR
First Name:ROGER
Middle Name:M
Last Name:HARRIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 714
Mailing Address - Street 2:
Mailing Address - City:HARTSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10530-0714
Mailing Address - Country:US
Mailing Address - Phone:914-713-0438
Mailing Address - Fax:
Practice Address - Street 1:34 S BROADWAY
Practice Address - Street 2:SUITE 206
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10601-4400
Practice Address - Country:US
Practice Address - Phone:914-761-1642
Practice Address - Fax:914-761-1644
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-19
Last Update Date:2007-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1612792084F0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084F0202XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyForensic Psychiatry