Provider Demographics
NPI:1437769213
Name:HARRIS, MARVIN L (TRANSPORTATION)
Entity Type:Individual
Prefix:MR
First Name:MARVIN
Middle Name:L
Last Name:HARRIS
Suffix:
Gender:M
Credentials:TRANSPORTATION
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 RIDGEWOOD PKWY
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23608-1918
Mailing Address - Country:US
Mailing Address - Phone:757-870-4916
Mailing Address - Fax:
Practice Address - Street 1:29 RIDGEWOOD PKWY
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23608-1918
Practice Address - Country:US
Practice Address - Phone:757-870-4916
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-05
Last Update Date:2020-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver