Provider Demographics
NPI:1821057001
Name:HARRIS, MARTIN C (DPM)
Entity Type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:C
Last Name:HARRIS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 WILKINS 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:508-695-1444
Mailing Address - Fax:508-695-6169
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:508-695-6169
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-17
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1521213E00000X
RI188213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
71242OtherBCBS WOONS
MAY70622OtherBLUE SHIELD OF MA
MA0334928Medicaid
RI0000007042OtherRHODE ISLAND BLUE SHIELD
RI203049OtherBLUE CHIP
2702001OtherUNITED HEALTH
MA0009562OtherNEIGHBORHOOD HEALTH
13038OtherHANCOCK
RI0012071OtherWELFARE
MA1521OtherREGISTERED POD
RI188OtherREGISTERED POD
33086OtherHPHC
715018OtherTUFTS IPA 13
MA1521OtherREGISTERED POD
RI188OtherREGISTERED POD
MA0334928Medicaid