Provider Demographics
NPI:1922174788
Name:HARRIS, MERLEEN (MD)
Entity Type:Individual
Prefix:DR
First Name:MERLEEN
Middle Name:
Last Name:HARRIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1333 KATIE LN
Mailing Address - Street 2:
Mailing Address - City:NORTH WALES
Mailing Address - State:PA
Mailing Address - Zip Code:19454-1336
Mailing Address - Country:US
Mailing Address - Phone:215-343-8418
Mailing Address - Fax:215-343-8419
Practice Address - Street 1:1333 KATIE LN
Practice Address - Street 2:
Practice Address - City:NORTH WALES
Practice Address - State:PA
Practice Address - Zip Code:19454-1336
Practice Address - Country:US
Practice Address - Phone:215-343-8418
Practice Address - Fax:215-343-8419
Is Sole Proprietor?:No
Enumeration Date:2006-11-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD034358E207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01220321Medicaid
PA183262Medicare ID - Type Unspecified
PAC32994Medicare UPIN