Provider Demographics
NPI:1629229364
Name:HARRIS, CHE MATTHEW (MD)
Entity Type:Individual
Prefix:DR
First Name:CHE
Middle Name:MATTHEW
Last Name:HARRIS
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 1:314 PALMSPRING DR
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20878-2941
Mailing Address - Country:US
Mailing Address - Phone:240-461-3873
Mailing Address - Fax:
Practice Address - Street 1:2041 GEORGIA AVENUE
Practice Address - Street 2:
Practice Address - City:WASHINGTON D.C
Practice Address - State:DC
Practice Address - Zip Code:20060
Practice Address - Country:US
Practice Address - Phone:202-865-6100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-30
Last Update Date:2009-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC111111111207R00000X
MDD68924207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD022548700Medicaid
MD157719Y82Medicare PIN