Provider Demographics
NPI:1730497116
Name:HARRIS, ROBIN B (LAC)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:B
Last Name:HARRIS
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5708 ROCKSPRING RD APT B
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21209-4359
Mailing Address - Country:US
Mailing Address - Phone:619-339-3020
Mailing Address - Fax:
Practice Address - Street 1:1515 LABELLE AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-6606
Practice Address - Country:US
Practice Address - Phone:619-339-3020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-19
Last Update Date:2010-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU01840171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist