Provider Demographics
NPI:1578733242
Name:HARRISON, DANIEL MENDEL (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:MENDEL
Last Name:HARRISON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 64526
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-4526
Mailing Address - Country:US
Mailing Address - Phone:410-706-5660
Mailing Address - Fax:
Practice Address - Street 1:16 S EUTAW STREET
Practice Address - Street 2:3RD FLOOT
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201
Practice Address - Country:US
Practice Address - Phone:410-328-3894
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-09
Last Update Date:2015-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY240225-12084N0400X
MDD694742084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD417960900Medicaid
MD160158YVAMedicare PIN