Provider Demographics
NPI:1538134770
Name:HARRIS, LISA YVETTE (MD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:YVETTE
Last Name:HARRIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:169 RIVERSIDE DR
Mailing Address - Street 2:ADMINISTRATION
Mailing Address - City:BINGHAMTON
Mailing Address - State:NY
Mailing Address - Zip Code:13905-4246
Mailing Address - Country:US
Mailing Address - Phone:607-798-5643
Mailing Address - Fax:607-798-7681
Practice Address - Street 1:415 E MAIN ST
Practice Address - Street 2:
Practice Address - City:ENDICOTT
Practice Address - State:NY
Practice Address - Zip Code:13760-4925
Practice Address - Country:US
Practice Address - Phone:607-785-2460
Practice Address - Fax:607-785-2584
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2014-03-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY204496207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1010674DLOtherPREFERRED CARE PEDIATRICS
NYP020204496OtherEXCELLUS BCBS COMMERCIAL
NY269914OtherGHI
NYP010204496OtherEXCELLUS BC BS HMO
NY000911856006OtherHEALTH NOW
NY5925757OtherAETNA
NY101674BJOtherPEFERRED CARE ADULTS
NYP010204496OtherEXCELLUS BC BS HMO
NY5925757OtherAETNA
NYJ400117915Medicare PIN
NYP020204496OtherEXCELLUS BCBS COMMERCIAL