Provider Demographics
NPI:1578544466
Name:HARRITY, BRIAN P (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:P
Last Name:HARRITY
Suffix:
Gender:M
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BUILDING 11-59, FTIG
Mailing Address - Street 2:
Mailing Address - City:ANNVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17003
Mailing Address - Country:US
Mailing Address - Phone:717-861-9409
Mailing Address - Fax:717-861-2655
Practice Address - Street 1:BUILDING 11-59, FTIG
Practice Address - Street 2:
Practice Address - City:ANNVILLE
Practice Address - State:PA
Practice Address - Zip Code:17003
Practice Address - Country:US
Practice Address - Phone:717-861-9409
Practice Address - Fax:717-861-2655
Is Sole Proprietor?:No
Enumeration Date:2005-11-08
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1053570363AM0700X
PAMA052518363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA154494KAGMedicare PIN