Healthcare Provider Details

I. General information

NPI: 1356343966
Provider Name (Legal Business Name): SCOTT E HARRISON PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2005
Last Update Date: 11/07/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 CHESTNUT HILL RD
STAFFORD SPRINGS CT
06076-4005
US

IV. Provider business mailing address

933 HEBRON AVE
GLASTONBURY CT
06033-2973
US

V. Phone/Fax

Practice location:
  • Phone: 860-679-2702
  • Fax: 860-272-2993
Mailing address:
  • Phone: 860-633-8794
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number001632
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: