Provider Demographics
NPI:1912900515
Name:HARRIS, ALAN C (MD)
Entity Type:Individual
Prefix:MR
First Name:ALAN
Middle Name:C
Last Name:HARRIS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:600 GRESHAM DR
Mailing Address - Street 2:SENTARA NORFOLK GENERAL HOSPITAL PATH DEPT
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23507-1904
Mailing Address - Country:US
Mailing Address - Phone:757-388-3221
Mailing Address - Fax:757-388-2137
Practice Address - Street 1:600 GRESHAM DR
Practice Address - Street 2:SENTARA NORFOLK GENERAL HOSPITAL PATH DEPT
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23507-1904
Practice Address - Country:US
Practice Address - Phone:757-388-3221
Practice Address - Fax:757-388-2137
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2010-11-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101036316207ZP0102X, 207ZH0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZH0000XAllopathic & Osteopathic PhysiciansPathologyHematology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0103147000Medicaid
KY64941909Medicaid
WV0827801Medicare ID - Type Unspecified
E91584Medicare UPIN
KY0512804Medicare ID - Type Unspecified
013969P28Medicare PIN