MEDICARE: DR. TIMOTHY RUSSELL HARRISON 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	0101246846	VA
2	207W00000X	Ophthalmology Physician	1525322	NY

General Provider Information

NPI Number	:	1811991300
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TIMOTHY RUSSELL HARRISON M.D.

Provider Business Mailing Address
First Line	:	17 N MEDICAL PARK DR
Second Line	:
City	:	FISHERSVILLE
State	:	VA
Zip	:	22939-2344
Country	:	US
Telephone Number	:	540-213-7720
Fax Number	:	540-213-7728

Provider Business Practice Location Address
First Line	:	62 HILL TOP LN
Second Line	:
City	:	LEXINGTON
State	:	VA
Zip	:	24450-5726
Country	:	US
Telephone Number	:	540-463-4140
Fax Number	:	540-463-4140

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

Provider Enumeration Date	:	06/13/2005
Last Update Date	:	06/01/2022

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