Provider Demographics
NPI:1861442709
Name:HARLAN, JOSEPH BENSON (MD)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:BENSON
Last Name:HARLAN
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 1:1209 YORK RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LUTHERVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21093-6220
Mailing Address - Country:US
Mailing Address - Phone:410-821-9490
Mailing Address - Fax:410-821-9495
Practice Address - Street 1:1209 YORK RD
Practice Address - Street 2:SUITE 200
Practice Address - City:LUTHERVILLE
Practice Address - State:MD
Practice Address - Zip Code:21093-6220
Practice Address - Country:US
Practice Address - Phone:410-821-9490
Practice Address - Fax:410-821-9495
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2012-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD53191207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDCC3778OtherR/R MEDICARE GROUP #
MD400804900Medicaid
MD180042054OtherR/R MEDICARE PROVIDER #
MDKR84594VMedicare PIN
MD400804900Medicaid
MDS572A369Medicare PIN