Provider Demographics
NPI:1689649626
Name:HARRIS, JEFFREY H (MD)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:H
Last Name:HARRIS
Suffix:
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 1:100 S HIGH ST
Mailing Address - Street 2:
Mailing Address - City:NEWVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17241-1409
Mailing Address - Country:US
Mailing Address - Phone:717-776-3114
Mailing Address - Fax:717-776-6003
Practice Address - Street 1:100 S HIGH ST
Practice Address - Street 2:
Practice Address - City:NEWVILLE
Practice Address - State:PA
Practice Address - Zip Code:17241-1409
Practice Address - Country:US
Practice Address - Phone:717-776-3114
Practice Address - Fax:717-776-6003
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD066172L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G64482Medicare UPIN
003463Medicare ID - Type Unspecified