Healthcare Provider Details

I. General information

NPI: 1235288283
Provider Name (Legal Business Name): CHARLES S. HARRIS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 04/22/2025
Certification Date: 04/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 HYGEIA DR
NEWARK DE
19713-2049
US

IV. Provider business mailing address

7337 LOCHHAVEN CT
ALLENTOWN PA
18106-9127
US

V. Phone/Fax

Practice location:
  • Phone: 302-273-1701
  • Fax: 302-273-4497
Mailing address:
  • Phone: 704-867-1562
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberC1-0027210
License Number StateDE
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberD0101773
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD068021L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: