Provider Demographics
NPI:1457301087
Name:HARRIS, ZENA (MD)
Entity Type:Individual
Prefix:
First Name:ZENA
Middle Name:
Last Name:HARRIS
Suffix:
Gender:F
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:VANDERBILT DEPARTMENT OF PEDIATRICS
Mailing Address - Street 2:2200 CHILDREN'S WAY, DOT#8153
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37232-0001
Mailing Address - Country:US
Mailing Address - Phone:615-936-8349
Mailing Address - Fax:615-343-4655
Practice Address - Street 1:VANDERBILT DEPARTMENT OF PEDIATRICS
Practice Address - Street 2:2200 CHILDREN'S WAY, DOT#8153
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37232-0001
Practice Address - Country:US
Practice Address - Phone:615-936-8349
Practice Address - Fax:615-343-4655
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-12
Last Update Date:2009-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD57584207LC0200X
TN44472208000000X, 2080P0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0203XAllopathic & Osteopathic PhysiciansPediatricsPediatric Critical Care Medicine
No207LC0200XAllopathic & Osteopathic PhysiciansAnesthesiologyCritical Care Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD365203300Medicaid
MDE84432Medicare UPIN
MDKR78C133Medicare ID - Type Unspecified