MEDICARE: DR. WALTER HARRIS M.D.

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	207W00000X	Ophthalmology Physician	MD039446E	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1689730905
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WALTER HARRIS M.D.

Provider Business Mailing Address
First Line	:	2000 HAMILTON ST
Second Line	:	RODIN PLACE SUITE 306
City	:	PHILADELPHIA
State	:	PA
Zip	:	19130-3814
Country	:	US
Telephone Number	:	215-545-5001
Fax Number	:	215-545-5763

Provider Business Practice Location Address
First Line	:	255 S 17TH ST
Second Line	:	SUITE 1002
City	:	PHILADELPHIA
State	:	PA
Zip	:	19103-6231
Country	:	US
Telephone Number	:	215-545-5001
Fax Number	:	215-545-5763

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

Provider Enumeration Date	:	12/29/2006
Last Update Date	:	09/14/2016

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Directions to “ DR. WALTER HARRIS M.D.” Practice Location

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