Provider Demographics
NPI:1518071471
Name:HARRIS, MARNA RACENE (MD)
Entity Type:Individual
Prefix:
First Name:MARNA
Middle Name:RACENE
Last Name:HARRIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARNA
Other - Middle Name:RACENE
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:14301 N 87TH ST STE 102
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-3687
Mailing Address - Country:US
Mailing Address - Phone:480-351-8188
Mailing Address - Fax:480-351-8187
Practice Address - Street 1:14301 N 87TH ST STE 102
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-3687
Practice Address - Country:US
Practice Address - Phone:480-351-8188
Practice Address - Fax:480-351-8187
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2016-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD423192208600000X
IL036.121054207L00000X
AZ43522207L00000X
CODR.0052234207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1012788070003Medicaid
AZ541644Medicaid
PAP00305449OtherRAILROAD MEDICARE
PA1743605OtherPERSONAL CHOICE
PA1012788070001Medicaid
PA1743605OtherHIGHMARK BLUE SHIELD
PA1012788070002Medicaid
PA2409329000OtherKEYSTONE IBC
PA2409329000OtherKEYSTONE IBC
PA1012788070001Medicaid
PAP00305449OtherRAILROAD MEDICARE