Provider Demographics
NPI:1508047085
Name:HARRIS, ROBERT ANTHONY (PA-C)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:ANTHONY
Last Name:HARRIS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2140 FIELDSTONE DR
Mailing Address - Street 2:
Mailing Address - City:N DIGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02764-1912
Mailing Address - Country:US
Mailing Address - Phone:508-669-6599
Mailing Address - Fax:617-698-4702
Practice Address - Street 1:100 HIGHLAND ST
Practice Address - Street 2:SUITE 105
Practice Address - City:MILTON
Practice Address - State:MA
Practice Address - Zip Code:02186-3881
Practice Address - Country:US
Practice Address - Phone:617-696-5030
Practice Address - Fax:617-698-4702
Is Sole Proprietor?:No
Enumeration Date:2007-11-26
Last Update Date:2007-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA736363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAS46932Medicare UPIN