Provider Demographics
NPI:1407859804
Name:HARRISON, JOSEPH ANDREW (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:ANDREW
Last Name:HARRISON
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 1:6 PARK PL
Mailing Address - Street 2:
Mailing Address - City:NEW BRITAIN
Mailing Address - State:CT
Mailing Address - Zip Code:06052-1403
Mailing Address - Country:US
Mailing Address - Phone:860-223-1124
Mailing Address - Fax:860-229-1185
Practice Address - Street 1:6 PARK PL
Practice Address - Street 2:
Practice Address - City:NEW BRITAIN
Practice Address - State:CT
Practice Address - Zip Code:06052-1403
Practice Address - Country:US
Practice Address - Phone:860-223-1124
Practice Address - Fax:860-229-1185
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2020-01-14
Deactivation Date:2006-03-20
Deactivation Code:
Reactivation Date:2006-03-24
Provider Licenses
StateLicense IDTaxonomies
CT22930207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001229301Medicaid
CT001229301Medicaid
CTDO2496Medicare UPIN