Provider Demographics
NPI:1811930852
Name:HARLAN, CARMEN Z (MD)
Entity type:Individual
Prefix:
First Name:CARMEN
Middle Name:Z
Last Name:HARLAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6614 SOUTHERN BLVD
Mailing Address - Street 2:
Mailing Address - City:BOARDMAN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-3455
Mailing Address - Country:US
Mailing Address - Phone:330-746-8056
Mailing Address - Fax:330-746-9152
Practice Address - Street 1:6614 SOUTHERN BLVD
Practice Address - Street 2:
Practice Address - City:BOARDMAN
Practice Address - State:OH
Practice Address - Zip Code:44512-3455
Practice Address - Country:US
Practice Address - Phone:330-746-8056
Practice Address - Fax:330-746-9152
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2021-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.0941392084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAH24217Medicare UPIN
PA042109Medicare ID - Type Unspecified
4270851Medicare UPIN