Provider Demographics
NPI:1295287357
Name:HARRIS, DAVID RANDY (CO)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:RANDY
Last Name:HARRIS
Suffix:
Gender:M
Credentials:CO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14300 CHERRY LANE CT
Mailing Address - Street 2:SUITE 213
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20707-4958
Mailing Address - Country:US
Mailing Address - Phone:301-776-5200
Mailing Address - Fax:301-776-4480
Practice Address - Street 1:14300 CHERRY LANE CT
Practice Address - Street 2:SUITE 213
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-4958
Practice Address - Country:US
Practice Address - Phone:301-776-5200
Practice Address - Fax:301-776-4480
Is Sole Proprietor?:No
Enumeration Date:2016-10-25
Last Update Date:2016-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDCO0016921744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management