Provider Demographics
NPI:1689869984
Name:LISA HARRIS MD PC
Entity Type:Organization
Organization Name:LISA HARRIS MD PC
Other - Org Name:TEMPLE MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:585-423-1880
Mailing Address - Street 1:14 FRANKLIN ST
Mailing Address - Street 2:SUITE 1010
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14604-1502
Mailing Address - Country:US
Mailing Address - Phone:585-423-1880
Mailing Address - Fax:
Practice Address - Street 1:14 FRANKLIN ST
Practice Address - Street 2:SUITE 1010
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14604-1502
Practice Address - Country:US
Practice Address - Phone:585-423-1880
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-10
Last Update Date:2009-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY204496207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
BA0001Medicare PIN