Provider Demographics
NPI:1629232244
Name:HARRIS, CORY (MD)
Entity Type:Individual
Prefix:
First Name:CORY
Middle Name:
Last Name:HARRIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3640 MAIN ST
Mailing Address - Street 2:STE 103
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01107-1139
Mailing Address - Country:US
Mailing Address - Phone:413-785-5321
Mailing Address - Fax:413-731-7130
Practice Address - Street 1:506 LENOX AVE
Practice Address - Street 2:DEPT OF SURGERY
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10037-1802
Practice Address - Country:US
Practice Address - Phone:212-939-8180
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-13
Last Update Date:2018-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY270568208800000X
MA272704208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology