Provider Demographics
NPI:1639279326
Name:HARRIS, ELLIOT M (MD)
Entity Type:Individual
Prefix:
First Name:ELLIOT
Middle Name:M
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 1:3 COOPER PLZ
Mailing Address - Street 2:SUITE 502
Mailing Address - City:CAMDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08103-1438
Mailing Address - Country:US
Mailing Address - Phone:856-968-7433
Mailing Address - Fax:
Practice Address - Street 1:1 COOPER PLZ
Practice Address - Street 2:COOPER UNIVERISTY EMERGENCY PHYISCIANS
Practice Address - City:CAMDEN
Practice Address - State:NJ
Practice Address - Zip Code:08103-1461
Practice Address - Country:US
Practice Address - Phone:856-342-2351
Practice Address - Fax:856-968-8272
Is Sole Proprietor?:No
Enumeration Date:2006-09-23
Last Update Date:2008-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA72306207PP0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PP0204XAllopathic & Osteopathic PhysiciansEmergency MedicinePediatric Emergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0537880OtherCIGNA
NJ2281166000OtherAMERIHEALTH/KEYSTONE/IBC
NJ3500962OtherAETNA
NJ60005776OtherHORIZON NJ HEALTH
NJ010006263 00OtherAMERICHOICE
NJ1602630OtherAMERIHEALTH PPO/PA BS
NJ8542601Medicaid
NJP3385893OtherOXFORD
NJ1295147OtherUNITED HEALTH PLAN
NJ30868OtherUNIVERISTY HEALTH PLAN
NJ30868OtherUNIVERISTY HEALTH PLAN
NJ3500962OtherAETNA