Provider Demographics
NPI:1922252048
Name:BRODY, HARRIS BOB (HMD, CN, HMD)
Entity Type:Individual
Prefix:DR
First Name:HARRIS
Middle Name:BOB
Last Name:BRODY
Suffix:
Gender:M
Credentials:HMD, CN, HMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:655 WEST COUNTY LINE RD.
Mailing Address - Street 2:
Mailing Address - City:HATBORO
Mailing Address - State:PA
Mailing Address - Zip Code:19040-1302
Mailing Address - Country:US
Mailing Address - Phone:215-443-9990
Mailing Address - Fax:215-443-9957
Practice Address - Street 1:655 WEST COUNTY LINE RD.
Practice Address - Street 2:
Practice Address - City:HATBORO
Practice Address - State:PA
Practice Address - Zip Code:19040
Practice Address - Country:US
Practice Address - Phone:215-443-9990
Practice Address - Fax:215-443-9957
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-17
Last Update Date:2010-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003749-1133N00000X
PACQ001369L174400000X
PACL022136L174400000X
DCNAT173175F00000X
NC200001706104175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist
No174400000XOther Service ProvidersSpecialist
No175F00000XOther Service ProvidersNaturopath