Provider Demographics
NPI:1679651517
Name:MARTIN C HARRIS DPM PC
Entity Type:Organization
Organization Name:MARTIN C HARRIS DPM PC
Other - Org Name:MARTIN C HARRIS DPM PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-695-1444
Mailing Address - Street 1:7 WILKENS DR
Mailing Address - Street 2:
Mailing Address - City:PLAINVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02762-2257
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7 WILKENS DR
Practice Address - Street 2:
Practice Address - City:PLAINVILLE
Practice Address - State:MA
Practice Address - Zip Code:02762-2257
Practice Address - Country:US
Practice Address - Phone:508-695-1444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA33086OtherHARVARD PILGRIM HEALTH
MA650462OtherTUFTS HEALTH PLAN
RI0012071Medicaid
MAY77085OtherBLUE SHEILD OF MA
MA9750703Medicaid
MAY77085Medicare PIN
MA650462OtherTUFTS HEALTH PLAN
MADC9767Medicare PIN
MA9750703Medicaid