Provider Demographics
NPI:1700850310
Name:HARRISON, HOWARD COURTENAY JR (MD)
Entity Type:Individual
Prefix:
First Name:HOWARD
Middle Name:COURTENAY
Last Name:HARRISON
Suffix:JR
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:PO BOX 7068
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23707-0068
Mailing Address - Country:US
Mailing Address - Phone:757-496-9020
Mailing Address - Fax:757-481-0638
Practice Address - Street 1:1168 FIRST COLONIAL RD
Practice Address - Street 2:SUITE 200
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23454-2426
Practice Address - Country:US
Practice Address - Phone:757-496-9020
Practice Address - Fax:757-481-0638
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2010-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101045401207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA37200OtherSENTARA/OPTIMA
VA461500OtherANTHEM
VA005881650Medicaid
VA541595397OtherMID ATLANTIC SOLUTIONS
VA541595397010OtherTRICARE
VA541595397OtherVIRGINIA HEALTH NETWORK
VA541595397OtherPRIVATE HEALTHCARE SYSTEM
VA541595397OtherAETNA
VA461500OtherANTHEM
VA005881650Medicaid