Provider Demographics
NPI:1609097302
Name:HARRISON, FAURN SHARMBRI (PA)
Entity Type:Individual
Prefix:
First Name:FAURN
Middle Name:SHARMBRI
Last Name:HARRISON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:FAURN
Other - Middle Name:SHARMBRI
Other - Last Name:ROUSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11350 MCCORMICK RD
Mailing Address - Street 2:EXECUTIVE PLAZA I, SUITE 501
Mailing Address - City:HUNT VALLEY
Mailing Address - State:MD
Mailing Address - Zip Code:21031-1002
Mailing Address - Country:US
Mailing Address - Phone:301-464-7008
Mailing Address - Fax:301-464-7011
Practice Address - Street 1:16900 SCIENCE DR
Practice Address - Street 2:SUITE 100
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20715-4401
Practice Address - Country:US
Practice Address - Phone:301-464-7008
Practice Address - Fax:301-464-7011
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0003081363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical