Provider Demographics
NPI:1982654034
Name:HARRIMAN, DAVID ALEXANDER (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:ALEXANDER
Last Name:HARRIMAN
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 1:1450 CHAPEL ST
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-4405
Mailing Address - Country:US
Mailing Address - Phone:203-779-3469
Mailing Address - Fax:203-867-5264
Practice Address - Street 1:1450 CHAPEL ST
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-4405
Practice Address - Country:US
Practice Address - Phone:203-789-3469
Practice Address - Fax:203-867-5264
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2013-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT047091207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD403646800Medicaid
CTD400025478Medicare Oscar/Certification
MD403646800Medicaid
MDH33873Medicare UPIN