Provider Demographics
NPI:1649334343
Name:HARRIS, HOWARD HAMILTON III (MD)
Entity type:Individual
Prefix:DR
First Name:HOWARD
Middle Name:HAMILTON
Last Name:HARRIS
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2790 GODWIN BLVD
Mailing Address - Street 2:SUITE 225
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23434-8151
Mailing Address - Country:US
Mailing Address - Phone:757-539-9005
Mailing Address - Fax:757-934-9438
Practice Address - Street 1:2790 GODWIN BLVD
Practice Address - Street 2:SUITE 225
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23434-8151
Practice Address - Country:US
Practice Address - Phone:757-539-9005
Practice Address - Fax:757-934-8438
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2008-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01012291402086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA288409OtherBLUE CROSS BLUE SHIELD
NC89063NTMedicaid
VA28788OtherSENTARA OPTIMA
VA28788OtherSENTARA OPTIMA
VAOOV158S77Medicare PIN