Provider Demographics
NPI:1619923877
Name:HARRIS, GREGORY G (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:G
Last Name:HARRIS
Suffix:
Gender:M
Credentials:MD, MPH
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1770 MASSACHUSETTS AVE # 271
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02140-2808
Mailing Address - Country:US
Mailing Address - Phone:617-983-0076
Mailing Address - Fax:877-991-8309
Practice Address - Street 1:1415 BEACON ST
Practice Address - Street 2:STE 320
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-4812
Practice Address - Country:US
Practice Address - Phone:617-983-0076
Practice Address - Fax:877-991-8309
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-26
Last Update Date:2020-12-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA795252084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAJ14771OtherPTAN
MAJ14771OtherBLUECROSS BLUESHIELD MA
MAHAJ14771OtherMEDICARE
MA3132439Medicaid
MAHAJ14771OtherMEDICARE