Provider Demographics
NPI:1619081726
Name:HARRIS, BERNARD AMIEL (MD,MPH)
Entity Type:Individual
Prefix:DR
First Name:BERNARD
Middle Name:AMIEL
Last Name:HARRIS
Suffix:
Gender:M
Credentials:MD,MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 E PROVIDENCE RD
Mailing Address - Street 2:
Mailing Address - City:YEADON
Mailing Address - State:PA
Mailing Address - Zip Code:19050-2823
Mailing Address - Country:US
Mailing Address - Phone:484-798-8906
Mailing Address - Fax:570-309-0190
Practice Address - Street 1:1128 MAIN ST APT 1F
Practice Address - Street 2:
Practice Address - City:DARBY
Practice Address - State:PA
Practice Address - Zip Code:19023-1230
Practice Address - Country:US
Practice Address - Phone:484-680-7575
Practice Address - Fax:570-309-0190
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2022-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD025875E2083P0901X, 207RA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction Medicine
No2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01-0935702Medicaid
PAHA193829Medicare ID - Type Unspecified
PA01-0935702Medicaid