Provider Demographics
NPI:1942208574
Name:HARRIS, RICHARD J (VMD, MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:J
Last Name:HARRIS
Suffix:
Gender:M
Credentials:VMD, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:340 MAIN ST
Mailing Address - Street 2:STE. 670
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01608-1604
Mailing Address - Country:US
Mailing Address - Phone:508-754-3566
Mailing Address - Fax:508-438-6364
Practice Address - Street 1:535 BOYLSTON ST
Practice Address - Street 2:7TH FLOOR
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02116-3720
Practice Address - Country:US
Practice Address - Phone:617-247-3444
Practice Address - Fax:617-247-9444
Is Sole Proprietor?:No
Enumeration Date:2005-07-08
Last Update Date:2011-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA214882207RC0000X, 207UN0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2097664Medicaid
F46883Medicare UPIN
MASX3642Medicare PIN
MAA38102Medicare PIN