Provider Demographics
NPI:1184734360
Name:HARRIS, PETER (MD)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:
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 1:165 SHERMAN DR
Mailing Address - Street 2:
Mailing Address - City:ST JOHNSBURY
Mailing Address - State:VT
Mailing Address - Zip Code:05819-9811
Mailing Address - Country:US
Mailing Address - Phone:802-334-3504
Mailing Address - Fax:802-334-3281
Practice Address - Street 1:82 MAPLE STREET
Practice Address - Street 2:
Practice Address - City:ISLAND POND
Practice Address - State:VT
Practice Address - Zip Code:05846
Practice Address - Country:US
Practice Address - Phone:802-723-4300
Practice Address - Fax:802-723-4544
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2015-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0420007993207R00000X
VT042.0007993207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT8000217OtherLADIES FIRST
VT810628OtherMVP
NH3008260Medicaid
VT110137555OtherRAILROAD MEDICARE
VT00028804OtherBLUE SHIELD
VT0009470Medicaid
VT810628OtherMVP
NH3008260Medicaid