Provider Demographics
NPI:1679691554
Name:HARRIS, TERRIE DUDA (CA MSTOM)
Entity type:Individual
Prefix:MS
First Name:TERRIE
Middle Name:DUDA
Last Name:HARRIS
Suffix:
Gender:F
Credentials:CA MSTOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9003 LINCOLN DR W STE H
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-3205
Mailing Address - Country:US
Mailing Address - Phone:856-797-9339
Mailing Address - Fax:856-797-9443
Practice Address - Street 1:9003 LINCOLN DR W STE H
Practice Address - Street 2:
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-3205
Practice Address - Country:US
Practice Address - Phone:856-797-9339
Practice Address - Fax:856-797-9443
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MZ00029700171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist