Provider Demographics
NPI:1962469049
Name:HARRIS, MILTON DEAN (MD)
Entity Type:Individual
Prefix:DR
First Name:MILTON
Middle Name:DEAN
Last Name:HARRIS
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:PO BOX 751803
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1803
Mailing Address - Country:US
Mailing Address - Phone:336-277-2000
Mailing Address - Fax:336-277-2050
Practice Address - Street 1:186 KIMEL PARK DR
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-6946
Practice Address - Country:US
Practice Address - Phone:336-277-2000
Practice Address - Fax:336-277-2050
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC20733207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC25038OtherMEDCOST
NC8939969Medicaid
NC207057OtherMPH PROVIDER NUMBER
NC060012388OtherMEDICARE RAILROAD
NC215893OtherMAMSI
NC2502153OtherUNITED HEALTH CARE
NC39969OtherBCNC
NC4098792OtherAETNA
NC144OtherPARTNERS MEDICARE
NC212257OtherFMC PROVIDER NUMBER
NCP00654535OtherRAILROAD MEDICARE
NC1441816003OtherCIGNA
NC215893OtherMAMSI
NCC84360Medicare UPIN
NC8939969Medicaid