Provider Demographics
NPI:1932393196
Name:HARRIS, COREY CARSON
Entity Type:Individual
Prefix:MR
First Name:COREY
Middle Name:CARSON
Last Name:HARRIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27663 EQUESTRIAN DR
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21801-1773
Mailing Address - Country:US
Mailing Address - Phone:443-480-0962
Mailing Address - Fax:
Practice Address - Street 1:27663 EQUESTRIAN DR
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21801-1773
Practice Address - Country:US
Practice Address - Phone:443-480-0962
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-30
Last Update Date:2007-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other