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NPI Code Detail

MEDICARE: DAVID A HARRISON PA-C

MEDICARE: DAVID A HARRISON PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant50-000558OH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1000000363292OTHEROHANTHEM

General Provider Information

NPI Number : 1548250293
Entity Type Code : Individual
Provider Name (Legal Business Name) : DAVID A HARRISON PA-C
Provider Business Mailing Address
First Line : PO BOX 951101
Second Line :
City : CLEVELAND
State : OH
Zip : 44193-0005
Country : US
Telephone Number : 440-879-0081
Fax Number : 440-879-0084
Provider Business Practice Location Address
First Line : 14519 DETROIT AVE
Second Line :
City : LAKEWOOD
State : OH
Zip : 44107-4316
Country : US
Telephone Number : 216-521-4200
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/25/2005
Last Update Date : 07/08/2007

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