MEDICARE: LONZO HARRIS

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
1	332BC3200X	Customized Equipment (DME)		VA

General Provider Information

NPI Number	:	1598189003
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LONZO HARRIS

Provider Business Mailing Address
First Line	:	12004 BELLAVERDE CIR APT 103
Second Line	:
City	:	NORTH CHESTERFIELD
State	:	VA
Zip	:	23235-4381
Country	:	US
Telephone Number	:	804-307-8879
Fax Number	:

Provider Business Practice Location Address
First Line	:	12004 BELLAVERDE CIR APT 103
Second Line	:
City	:	NORTH CHESTERFIELD
State	:	VA
Zip	:	23235-4381
Country	:	US
Telephone Number	:	804-307-8879
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/05/2014
Last Update Date	:	04/04/2019

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