Provider Demographics
NPI:1922564160
Name:HARRIS, DYLAN
Entity Type:Individual
Prefix:
First Name:DYLAN
Middle Name:
Last Name:HARRIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1036 HATCHET RD
Mailing Address - Street 2:
Mailing Address - City:SAXE
Mailing Address - State:VA
Mailing Address - Zip Code:23967-5326
Mailing Address - Country:US
Mailing Address - Phone:434-568-7463
Mailing Address - Fax:
Practice Address - Street 1:1036 HATCHET RD
Practice Address - Street 2:
Practice Address - City:SAXE
Practice Address - State:VA
Practice Address - Zip Code:23967-5326
Practice Address - Country:US
Practice Address - Phone:434-568-7463
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-12
Last Update Date:2019-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)