Provider Demographics
NPI:1629148911
Name:HARKER, PHENTON TRAVIS (MD)
Entity Type:Individual
Prefix:
First Name:PHENTON
Middle Name:TRAVIS
Last Name:HARKER
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 1:250 PLEASANT ST
Mailing Address - Street 2:CRFHC
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-7539
Mailing Address - Country:US
Mailing Address - Phone:603-228-7200
Mailing Address - Fax:603-228-7307
Practice Address - Street 1:250 PLEASANT ST
Practice Address - Street 2:CRFHC
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-7539
Practice Address - Country:US
Practice Address - Phone:603-228-7200
Practice Address - Fax:603-228-7307
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH13320207Q00000X, 2083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Not Answered2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH4491080OtherCIGNA INSURANCE
NH4152065OtherMVP INSURANCE
NH3375424OtherAETNA INSURANCE
NH30206388Medicaid
NHAA75724OtherHARVARD PILGRIM INSURANCE
NH3375424OtherAETNA INSURANCE
NH4491080OtherCIGNA INSURANCE