Provider Demographics
NPI:1477510279
Name:HARRIS, VIGILA CONSTANCE (MD FAAP)
Entity Type:Individual
Prefix:DR
First Name:VIGILA
Middle Name:CONSTANCE
Last Name:HARRIS
Suffix:
Gender:F
Credentials:MD FAAP
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Mailing Address - Street 1:9135 PISCATAWAY RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CLINTON
Mailing Address - State:MD
Mailing Address - Zip Code:20735
Mailing Address - Country:US
Mailing Address - Phone:301-856-2210
Mailing Address - Fax:301-856-2212
Practice Address - Street 1:9135 PISCATAWAY RD
Practice Address - Street 2:SUITE 200
Practice Address - City:CLINTON
Practice Address - State:MD
Practice Address - Zip Code:20735
Practice Address - Country:US
Practice Address - Phone:301-856-2210
Practice Address - Fax:301-856-2212
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-27
Last Update Date:2024-01-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDD0019546208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
D09286Medicare UPIN