Provider Demographics
NPI:1205576378
Name:HARRISON, THOMAS ANTONIO
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:ANTONIO
Last Name:HARRISON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:THOMAS
Other - Middle Name:ANTONIO
Other - Last Name:HARRISON-MAYO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:12370 MOUNT CLARE PL UNIT 12303
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20601-4555
Mailing Address - Country:US
Mailing Address - Phone:202-567-8355
Mailing Address - Fax:
Practice Address - Street 1:4512 EADS ST NE APT 4
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20019-4686
Practice Address - Country:US
Practice Address - Phone:202-567-8355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-29
Last Update Date:2022-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant